scholarly journals Mapping of Rural Health Services during Covid-19 Pandemic in Central Java, Indonesia: Rethinking Remoteness

2021 ◽  
Vol 887 (1) ◽  
pp. 012032
Author(s):  
I. Andini ◽  
A. Djunaedi

Abstract Covidl9 pandemic, since 2019 in global world and 2020 in Indonesia, changed human daily life and affected the provision of public services, especially health services. As Covid19 spread through close interactions among humans, rural areas have the advantage of remoteness compared to higher-density urban areas. In the villages with relatively isolated access, the spread of Covid-19 is very low compared to the national average. This paper discusses how remoteness has become two sides of the coin during pandemic by examining at the data of health services in three rural areas in Provinsi Jawa Tengah, Indonesia. Data collected by in-depth interviews showed that although remoteness became a key factor in delaying the spread of Covid19, it also became a key factor in the deterioration of advanced health services in non-covid diseases throughout the pandemic. These findings confirmed the vulnerability of basic services in rural areas, even on Java Island as a center of growth in Indonesia. Using causal network analysis, the discussion revealed that the vulnerability stem from the territorial approach in health service provision making rural areas less resilient during pandemic. This paper concludes that while remoteness provides a barrier in retaining the spread of pandemic disease, it also worsens the medical treatment capacity in non-pandemic diseases in rural areas. Covid19 pandemic raises the need of specific arrangement public health services in remote rural areas.

Author(s):  
Marian Gogola ◽  
Dana Sitányiová

Rural areas still have some disadvantages in comparison to urban areas. Access to jobs, education, or health services provided for inhabitants in rural areas are limited. Another important topic is mobility, which is crucial to meet the travel expectations of inhabitants in rural areas. Finding new forms of mobility capable of covering all areas and meeting the requirements of rural inhabitants is the most important challenge. This chapter deals with mobility in rural areas from the perspective of demographics, social change, and accessibility to transport services. Moreover, this chapter offers various case studies dealing with innovative solutions for mobility in rural areas resulting from the RUMOBIL project.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Background Many countries across Europe are facing considerable challenges in providing accessible and high quality care regardless of where people live. A major element is the difficulty that countries face to attract and retain health care professionals to work in remote and rural areas. This applies to primary care services as well as to hospital care, and to the care provided by physicians and other health professionals, including nurses. A widely shared question is therefore how to safeguard access to health care in rural areas and to solve recruitment and retention problems in such regions, both of medical and nursing staff. The workshop will build on last year’s joint workshop of the Sections on HSR and HWR that ended with questions related to how to organize accessible and equitable health services including the workforces required to do so. Objectives This workshop will provide a snapshot of studies from across the European region, with a particular focus on differences between rural and urban health care practices and the types of solutions being used to reduce regional disparities in provision of care. This often refers to retention and recruitment strategies, but the session will also address other types of solutions in the organization of care that can help ensure accessible care, including in vulnerable regions and settings. Tackling this challenge will therefore require a joint approach, tapping into experience from health workforce research as well as wider health services research, bringing together research into the organization and management of healthcare and into the health human resources providing this care, operated from different angles and being informed by different research traditions and data sources. Based on statements, we will discuss the topic of how to organize accessible and equitable health services including the workforces required to do so after the presentations. Key messages Workforce policies should focus on retaining primary care workforce in rural areas and integrated policies should attract new primary care practices. Both in primary care and hospital care new solutions are being sought which should help resolve regional differences in access to care and attractiveness for the health workforce.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Delu Yin ◽  
Tao Yin ◽  
Huiming Yang ◽  
Lihong Wang ◽  
Bowen Chen

Abstract Background No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas. Methods Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service. Results Village doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14 to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%. Conclusions The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.


BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029059
Author(s):  
Philippe Bocquier ◽  
Abdramane Bassiahi Soura ◽  
Souleymane Sanogo ◽  
Sara Randall

BackgroundSelective migration may affect health indicators in both urban and rural areas. Sub-Saharan African urban areas show evidence of both negative and positive selection on health status at outmigration. Health outcomes as measured in urban populations may not reflect local health risks and access to health services.MethodsUsing the Ouagadougou Health and Demographic Surveillance System and a migrant follow-up survey, we measured differences in health between matched non-migrants and outmigrants. We applied Cox and competing risks models on migration and death.ResultsControlling for premigration health status, migrants who moved out of Ouagadougou have higher mortality (HR 3.24, 95% CI 1.23 to 8.58) than non-migrants and migrants moving to other Ouagadougou areas. However, these effects vanish in the matched sample controlling for all interactions between death determinants. These and other results show little evidence that migration led to higher mortality or worse health.ConclusionsHealth outcomes as measured in Ouagadougou population do reflect local health risks and access to health services despite high migration intensity. However, neither the hypothesis of effect of health on migration nor the hypothesis of negative effect of migration on health or survival was confirmed.


2016 ◽  
Vol 74 (4) ◽  
pp. 339-359
Author(s):  
Stefan Neumeier

Abstract In many rural areas in Europe a spatial concentrating of basic services can be observed due to interacting socioeconomic and demographic processes. At the European level, territorial cohesion policy aims at mitigating the consequences of this development. Additionally, in Germany, this development is a greatly discussed topic. However, little data exists at the country level on the dimensions and consequences of this spatial concentration process. This limitation makes it difficult to realistically assess the situation and identify the regions and basic services where intervention may be required. As a contribution to bridging this knowledge gap, we used a GIS accessibility analysis to analyse the regional distribution of ambulant nursing services throughout Germany and to estimate the availability of such services near patients’ places of residence. Ambulant nursing care is an important basic service of the German health care system; such services allow disabled or elderly people who are not able to fully care for themselves to stay in their homes and living environments. The analysis results lead us to conclude that although ambulant nursing services must cover greater distances to reach customers in rural areas, at present such services are nationally available in rural areas as well as in urban areas.


2021 ◽  
Vol 24 (1) ◽  
pp. 68-78
Author(s):  
Rukmini Rukmini ◽  
Lusi Kristiani

One of the health efforts that have the opportunity to improve the health status of the elderly is traditional health services (Yankestrad). This paper aims to describe the use of Yankestrad among the elderly in Indonesia. The data source in this analysis is Riskesdas 2018, a research conducted by the Ministry of Health with the elderly (≥60 years) as the analysis unit. Data were analyzed descriptively. The results showed that the use of Yankestrad in the elderly was 37.0% and self-medication with traditional medicine was 17.3%. Young elderly people mostly use Yankestrad (37.9%), while self-medication with traditional medicine are dominated by elderly women (18.3%) in rural areas (19.5%). The use of Toga in the elderly in Indonesia (31.9%), mostly women (33.3%) in rural areas (36.3%). The most common types of Yankestrad used by the elderly were manual skills, potions, and homemade potions. Male elderly (55.5%) in urban areas (56.5%) used more prepared ingredients, while female elderly (43.6%) in rural areas (46.5%) preferred homemade ingredients. Older people with low expenditure levels tend to take advantage of prepared ingredients or homemade ingredients, while high expenditures tend to take advantage of manual skills. Traditional healers (98.2%) are the type of yakestrad used mostly by the elderly. In conclusion, Yankestrad in Indonesia is mostly used by the elderly, therefore it has the potential to be developed as an alternative model of health services for the elderly. Given the high interest of the elderly with Yankestrad and the use of traditional healers, it is necessary to provide Yankestrad facilities, especially in Puskesmas with traditional health workers who are able to provide safe and quality health services to the elderly. Abstrak Salah satu upaya kesehatan yang berpeluang meningkatkan status kesehatan lansia adalah pelayanan kesehatan tradisional (Yankestrad). Tulisan ini bertujuan untuk mengetahui gambaran pemanfaatan Yankestrad pada penduduk lansia di Indonesia. Sumber data dalam analisis ini adalah Riskesdas 2018. Riset yang dilakukan oleh Kementerian Kesehatan dengan unit analisis lansia (≥60 tahun). Analisis data secara deskriptif. Hasil menunjukkan, pemanfaatan Yankestrad pada lansia 37,0% dan upaya sendiri dengan obat tradisional 17,3%. Lansia muda terbanyak memanfaatkan Yankestrad (37,9%), sedangkan upaya sendiri dengan obat tradisonal didominasi lansia perempuan (18,3%) di perdesaan (19,5%). Pemanfaatan Toga pada lansia di Indonesia (31,9%), terbanyak perempuan (33,3%) di perdesaan (36,3%). Jenis Yankestrad terbanyak dimanfaatkan lansia adalah keterampilan manual, ramuan jadi dan ramuan buatan sendiri. Lansia laki-laki (55,5%) di perkotaan (56,5%) lebih banyak memanfaatkan ramuan jadi, sedangkan lansia perempuan (43,6%) di perdesaan (46,5%) lebih menyukai ramuan buatan sendiri. Lansia dengan tingkat pengeluaran rendah cenderung memanfaatkan ramuan jadi atau ramuan buatan sendiri, sedangkan pengeluaran tinggi cenderung memanfaatkan ketrampilan manual. Penyehat tradisional (98,2%) adalah jenis tenaga terbanyak dimanfaatkan lansia. Kesimpulan, Yankestrad di Indonesia lebih banyak dimanfaatkan oleh lansia, oleh karena itu berpotensi untuk dikembangkan sebagai alternatif model pelayanan kesehatan bagi lansia. Rekomendasi, mengingat tingginya minat para lansia dengan Yankestrad dan pemanfaatan penyehat tradisional, maka diperlukan penyediaan fasilitas Yankestrad khususnya di Puskesmas dengan tenaga kesehatan tradisional yang mampu memberikan pelayanan kesehatan yang aman dan berkualitas bagi para lansia.


In KwaZulu-Natal more than 50% of the population lives in the rural area but most of the health workers are based in urban centres where teaching hospitals and high incomes are common. Nursing provides the backbone of health care in the public sector. Specialist nurses such as advanced midwives or specialist HIV nurses are in short supply. Teaching via live synchronous videoconference (VC) provides an opportunity to extend specialist education to nurses at rural hospitals. Aim: The aim of the study was to review and evaluate the current use of videoconference education for nurses in KwaZulu-Natal. Methodology: A review the literature on VC education in nursing using bibliometric review strategies was conducted and two nurses’ education courses conducted via videoconferencing was evaluated against a set of criteria developed and validated by the Department of TeleHealth at the University. Results: 81 publications addressing videoconference nurse education were found, most being published after 2000. Over half were descriptive studies, but were still valuable for informing this study. Based on the evaluation of the two courses against the set of criteria, the two courses were aligned sufficiently well with the measurement criteria. Additionally, the delivery of the courses via videoconferencing allowed for the identification of potential cost savings. Discussion: This evaluation indicates that these two courses have been successfully implemented using VC. In the light of the potential savings of time and money, VC can be used to teach specialist nursing courses to rural nurses. Recommendations to improve the VC courses included orientation training for presenters and encouraging more research regarding the effectiveness of VC as a teaching modality for clinical nurses in rural areas. Conclusion: More attention should be given to developing the infrastructure and skills to make this technology available and commonly used in health services in under-resourced public health services and hospitals. Additional research is also suggested.


2016 ◽  
Vol 14 (4) ◽  
pp. 836 ◽  
Author(s):  
David M. Scott ◽  
Mark Strand ◽  
Teri Undem ◽  
Gabrielle Anderson ◽  
Andrea Clarens ◽  
...  

2021 ◽  
Author(s):  
Emily D Carter ◽  
Linnea Zimmerman ◽  
Ellie Qian ◽  
Tim Roberton ◽  
Assefa Seme ◽  
...  

Background: The COVID-19 pandemic and response have the potential to disrupt access and use of reproductive, maternal, and newborn health (RMNH) services. Numerous initiatives aim to gauge the indirect impact of COVID-19 on RMNH. Methods: We assessed the impact of COVID-19 on RMNH coverage in the early stages of the pandemic using panel survey data from PMA-Ethiopia. Enrolled pregnant women were surveyed 6-weeks post-birth. We compared the odds of service receipt, coverage of RMNCH service indicators, and health outcomes within the cohort of women who gave birth prior to the pandemic and the COVID-19 affected cohort. We calculated impacts nationally and by urbanicity. Results: This dataset shows little disruption of RMNH services in Ethiopia in the initial months of the pandemic. There were no significant reductions in women seeking health services or the content of services they received for either preventative or curative interventions. In rural areas, a greater proportion of women in the COVID-19 affected cohort sought care for peripartum complications, ANC, PNC, and care for sick newborns. Significant reductions in coverage of BCG vaccination and chlorohexidine use in urban areas were observed in the COVID-19 affected cohort. An increased proportion of women in Addis Ababa reported postpartum family planning in the COVID-19 affected cohort. Despite the lack of evidence of reduced health services, the data suggest increased stillbirths in the COVID-19 affected cohort. Discussion: The government of Ethiopia's response to control the COVID-19 pandemic and ensure continuity of essential health services appears to have successfully averted most negative impacts on maternal and neonatal care. This analysis cannot address the later effects of the pandemic and may not capture more acute or geographically isolated reductions in coverage. Continued efforts are needed to ensure that essential health services are maintained and even strengthened to prevent indirect loss of life.


Author(s):  
Shakeel A. Mir ◽  
Danish Shakeel

Background: Adherence is a key factor in the success of all pharmacological therapies. Medication non-adherence is an extremely common barrier to achieve positive health outcomes. The present study aims to compare medication non-adherence in some common chronic diseases and cancers and also to assess various factors influencing it.Methods: Pre-validated questionnaires based on general medication adherence scale (GMAS) were equally distributed among 300 patients suffering from chronic illnesses and cancers. 270 patients returned completely filled questionnaires.Results: The study population consists of 53.33% men and 46.66% women.55.55% patients were literate. 70.37% of patients were from rural areas. 61.48% were taking 2-4 drugs. As compared to 14.81% males 18.51% of females had poor or low adherence. Only 0.74% of young patients (<30 years) had poor/low adherence as compared to 16.29% each in other age groups. Rural patients had poor adherence as compared to patients from urban areas. As compared to 31.85% illiterate patients, only 16.29% of literate patients had poor or low adherence. Adherence was better in patients taking more than one drug. Statistically, a significant correlation was found between gender, age, level of education, and area of residence. Duration of treatment, the number of drugs, and the frequency of dosage were not found significantly correlated with adherence. Patients suffering from malignancies had higher medication adherence as compared to chronic illnesses.Conclusions: Medication non-adherence is common in patients with chronic diseases and cancers that are treated with unsupervised oral antineoplastic drugs. The complex problem of non-adherence calls for interventions at various levels.


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