scholarly journals Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Tanvir Ahmed ◽  
Syed Jafar Raza Rizvi ◽  
Sabrina Rasheed ◽  
Mohammad Iqbal ◽  
Abbas Bhuiya ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Information ◽  
Mobile Phones ◽  
Access To Health Care ◽  
Digital Health ◽  
Electronic Devices ◽  
Technical Skill ◽  
Integrating Technology ◽  
Access To Health

BACKGROUND Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. OBJECTIVE This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. METHODS A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). RESULTS A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. CONCLUSIONS Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care.

scholarly journals Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study

10.2196/16473 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16473
Author(s):  
Tanvir Ahmed ◽  
Syed Jafar Raza Rizvi ◽  
Sabrina Rasheed ◽  
Mohammad Iqbal ◽  
Abbas Bhuiya ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Information ◽  
Mobile Phones ◽  
Access To Health Care ◽  
Digital Health ◽  
Electronic Devices ◽  
Technical Skill ◽  
Integrating Technology ◽  
Access To Health

Background Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

scholarly journals Health mediator model as a way to access to care and health information for Syrian refugees in Turkey

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
I Kayi ◽  
Z Şimşek2 ◽  
G Yıldırımkaya
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Legal Status ◽  
Healthcare Access ◽  
Syrian Refugees ◽  
Care Services ◽  
Access To Health ◽  
The City

Abstract The number of Syrian refugees residing in Turkey has increased over 200 times since 2012 reaching to 3,621,330 (April 2019). Turkey has granted temporary protection status, including access healthcare in the city of registration. Ministry of Health provides on-site health service in temporary shelters, however more than 90% of the Syrian refugees choose to stay in community settings, which along with language barriers limits their ability to access health care and information. With UNFPA we have designed a health mediator model to improve access to health care and awareness on priority concerns such as mental health, reproductive health, child health, health system in Turkey and legal status provided to Syrian refugees. This study is a participatory operational research to test the health mediator model. Operationalization took place in 3 phases: (1) selection and training of Syrian health mediators and provincial coordinators; (2) household visits and data collection; (3) evaluation and supervision. So far, we have trained 174 health mediators from 24 different Turkish cities. Training took 5 days with up to 30 participants each. UNFPA collaborated with NGOs that work with Syrian refugees for coordination purposes. Health mediators made household visits to reach out to Syrian families, gave health education and where necessary support for access to health care services, and conducted a needs assessment. Data collected has been the subject to weekly supervision meetings by local NGOs, health mediators and coordinators to set priorities for the upcoming week. Health mediator model was effective in reaching out to hard-to-reach groups among Syrian refugees, increased health system and legal awareness, contribute to improved healthcare access and prevention of negative health outcomes such as teenage marriages and pregnancies. Inclusion of refugees in decision-making and guidance during the implementation of the project was key for project success.

scholarly journals Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Rolke ◽  
J Wenner ◽  
O Razum
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Chronic Illnesses ◽  
Point Of View ◽  
Informal Support ◽  
Federal State ◽  
Health Card ◽  
Delayed Treatment ◽  
Access To Health

Abstract Background The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care. Methods A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti. Results Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time. Conclusions Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system. Key messages The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.

scholarly journals HEALTH UNDER OCCUPATION Counter Strategies and Resistance Tactics of Palestinians and the Health System in the State of Palestine

2019 ◽  
Author(s):  
Sigge Andersson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
The State ◽  
Health Determinants ◽  
Theory Approach ◽  
Access To Health ◽  
The Impact

The impact of occupation on health and access to health care is a significant issue for the state, health sector and citizens of Palestine, who struggle with difficulties related to an enduring sociopolitical stalemate. The study presents narratives from the field, conceptually exploring if and how occupation affects health and access to health care and how the situation is tackled by Palestinians in general and by health system actors specifically. A grounded theory approach analyzing in-depth interviews with health staff and field memos was used, with semi-quantification of emerging concepts through surveys of Hebron students that assessed health-related quality of life and health literacy with psychometric instruments (SF36 and GSE) and assumed health determinants. One key theme in the data analysis was isolation as a result of multiple barriers, including the wall and checkpoints, imprisonment and violence, which have an impact on determinants of health and quality of life in Palestine. In the survey 54% (n=90) were affected by such factors of occupation. Barriers affect access to health care, especially in rural areas. Mentally and materially breaking free from barriers of occupation seems to be a common task in all levels of Palestinian society. Achieving this goal requires different counter strategies and tactics. Presently, Palestine depends on ad hoc coping strategies, including the use of mobile clinics. Other ways to cope emerged in the data as well. Results from this mixed-methods study suggest that isolation is a main concern for Palestinians, resulting from barriers in policies of occupation that affect health and access to health care. Another concept emerging from the analysis was tactics and strategies against occupation in society.

scholarly journals Exploring the views of undocumented migrant women on access to maternity services in the UK

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Hargreaves ◽  
L B Nellums ◽  
J Powis ◽  
L Jones ◽  
A Miller ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Policies ◽  
Migrant Women ◽  
Undocumented Migrant ◽  
Maternity Services ◽  
Access To Health ◽  
The Uk ◽  
Detrimental Impact

Abstract Background Migrant women face inequalities in access to health-care services and are known to experience poorer maternal and child outcomes than women born in the UK. The development of more restrictive health policies in the UK and Europe, including being denied or charged for healthcare at maternity services, may be exacerbating these outcomes, particularly among undocumented migrant women without permission to reside. We investigated undocumented migrant women's experiences of accessing maternity services in the UK and their impact on health outcomes. Methods We did semi-structured in-depth qualitative interviews with a purposive sample of migrant women (born outside the UK) who were aged 18 and over, and had experiences of pregnancy in the UK whilst undocumented. Participants were recruited through the Doctors of the World UK clinic. Interviews were transcribed and analysed using thematic analysis. Results We did interviews with 20 undocumented women (age range 31-40 years; mainly from Africa and Asia). Among participants, of whom 13 were pregnant at the time of interview, 10 (50%) first accessed antenatal care late (after the national target of 13 weeks). Women described an ongoing cycle of precariousness, defined by their legal status, social isolation, and poor economic status. Women reported receiving bills of up to £11,500 for maternity services (range £3,072 to £11.500). The impact of their experiences meant that they were deterred from seeking timely health care and were reluctant to present to health services, with women reporting fear and loss of trust in the health system. Conclusions These women's narratives illustrated the potential deterrent and detrimental impact of increasingly restrictive health policies on women's access to care and their health. UK and European health policies must be equitable, non-discriminatory, and better align with our commitments to promote universal health coverage among all individual residing in the region. Key messages Increasingly restrictive health policies may have a deterrent and detrimental impact on migrant women’s access to health care. Undocumented migrant women in the UK reported fear and loss of trust in the health system.

scholarly journals The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study

10.2196/16783 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16783
Author(s):  
Kate Jongbloed ◽  
Margo E Pearce ◽  
Vicky Thomas ◽  
Richa Sharma ◽  
Sherri Pooyak ◽  
...  
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Mobile Phone ◽  
Indigenous People ◽  
Mobile Phones ◽  
Exploratory Study ◽  
Access To Health Care ◽  
Mobile Phone Use ◽  
Access To Health ◽  
Prevention And Treatment

Background Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.

How accessible is the Serbian health system? Main barriers and challenges ahead

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Hernandez-Quevedo ◽  
V Bjegovic-Mikanovic ◽  
M Vasic ◽  
D Vukovic ◽  
J Jankovic ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Medical Care ◽  
Access To Health Care ◽  
Unmet Need ◽  
Policy Issue ◽  
Vulnerable Groups ◽  
Free Access ◽  
Access To Health ◽  
Underlying Causes

Abstract Background Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes. Methods We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country. Results We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia. Conclusions Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations. Key messages Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.

scholarly journals Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 104-113
Author(s):  
Krishna Chaitanya Vadlamannati ◽  
Arusha Cooray ◽  
Indra de Soysa
Keyword(s):  
Health Care ◽  
Social Capital ◽  
Health System ◽  
Access To Health Care ◽  
Opposite Effect ◽  
Adverse Outcomes ◽  
Societal Factors ◽  
Testing Procedures ◽  
Factors Associated ◽  
Access To Health

Aims: The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more ‘egalitarian’ forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust. Methods: We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy. Results: Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity. Conclusions: Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.

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