Accessibility to Non-COVID Health Services in the World During the COVID-19 Pandemic: Review

Background: COVID-19 pandemic caused by SARS-CoV2 has seriously impacted the global economy. Medical facilities around the world were not prepared for the enormous challenges posed by the growing number of patients each day, the shortage of personal protective equipment, and insufficient numbers of medical staff. Governments have tried to counteract the impact of the pandemic, but the measures taken have not always been sufficient to maintain access to and quality of health services at the same level as before the pandemic. The disruption of health services has resulted in more and more research reports from different parts of the world on the accessibility of health services during the COVID-19 pandemic.Methodology: This review article presents 21 selected scientific studies on access to health services in different regions of the world. Articles were found in PubMed, GoogleScholar, Medline, and ScienceDirect databases, then grouped, and significant data were extracted from each article. The results were summarized in a table.Results: The range of limited health services included a variety of specialties, including primary care, psychiatry, orthopedics, cardiology, neurosurgery, and more. Methods used in the studies were based on retrospective analysis or on the subjective assessment of patients in the form of a questionnaire or interview. Most authors claimed a decrease in accessibility to health services during the COVID-19 pandemic compared to the pre-pandemic period, including a decrease in planned surgeries, doctor appointments, patient admission to hospital or ER, and access to medicines. Additionally, some authors observed an increase in the mortality rate. One of the few medical services that have expanded rapidly during the pandemic was online appointments.Conclusions: The COVID-19 pandemic has most certainly affected the accessibility of health services worldwide. Lessons should be learned to prevent inaccessibility to medical services, especially as experts predict another wave of COVID-19 cases.

The Impact of Armed Conflict on Utilisation of Health Services in North-West Syria: An Observational Study

BackgroundArmed conflicts are known to have detrimental impact on availability and accessibility of health services. Consequently, utilisation of healthcare is usually affected. However, little is known on the extent of these effects largely due to challenges facing research in such settings. This study examines whether exposure to war incidents affected utilisation of key health services in conflict affected areas of north west Syria between 1 October 2014 and 30 June 2017.MethodsThe study is an observational study using routinely collected data in 8 health facilities in north west Syria and a database on conflict incidents. Longitudinal panel data analysis was used with fixed effect negative binomial regression for the monthly analysis and distributed lag model with a lag period of 30 days for the daily analysis.ResultsThe study found strong evidence for a negative association between bombardments and both consultations and antenatal care visits. The monthly Risk Ratio was 0.95 (95%CI: 0.94-0.97) and 0.95 (95%CI: 0.93-0.98) respectively; and the cumulative daily RR at 30 days was 0·19 (95%CI: 0·15 - 0·25) and 0·42 (95%CI: 0·25 - 0·69) for consultations and antenatal care respectively. Explosions were found to be associated with an increase in the number of deliveries and C-sections. The data provides evidence that each one unit increase in explosions in a given month in a given village was associated with about 20% increase in deliveries and C-sections; RR was 1·22 (95%CI: 1·05-1·42) and 1·96 (95%CI: 1·03-3·74) respectively.ConclusionThe study found that access to healthcare in affected areas in Syria has been limited. The study also provides evidence that conflict incidents were associated negatively with the utilisation of health services. Based on this evidence, health actors in conflict settings need to adopt strategies that ensure availability and accessibility of health services such as decentralisation and outreach health services.

Factors contributing to inequality in access to urban health service delivery in low resource setting country

Background Health is considered as constitutional and fundamental right for general people in Bangladesh. Due to poor socio-economic conditions, income disparities, and socio-cultural barriers, many poor people have limited accessibility in health services and also unable to afford quality health care. This study attempts to examine the factors associated with accessibility and affordability of urban health services. Methods This is an explanatory research which is being carried out using mixed research approach. Primary data was collected using simple random sampling technique from 150 household’s residents in Sylhet City who have experience in receiving services from the urban public health care centers. This study uses a structured interview schedule including both open ended as well as close ended questions. Moreover, descriptive statistics are used for analyzing field data for understanding accessibility of health services. Results This study found that 56% urban poor people have inadequate accessibility of health services as they have different types of financial difficulties including maintaining medical expenditure. The health system prevail discrepancy between mentioned services in citizen charter and availability of services as education and the existence of superstitions significantly impact on access to public health care but religion and age have a little impact in getting health services. Most of the respondents either satisfied (47%) or highly satisfied (29%) with the cordiality of senior consultants, and almost half of the respondents assumed the standard of cabin service is satisfactory (44%) as well as highly satisfactory (2%); however, wealthy and powerful people of the society always get privileges over disadvantaged people paying extra money or social network to get a cabin. Unfortunately, the professionalism of nurses and 4th class employees of public hospitals are not satisfactory. Moreover, there exists a high level of corruption and bureaucratic resistance in public hospitals which hinders equal access of general people to get services. The economic and cultural factors in this research are not highly influential issues for access to health care, but adequate information is one of the challenges for access to health care. Besides, administrative factors in this study have significant influence on the accessibility of health services. Conclusion Equal access to health services from public providers are prime need and right for every resident in Sylhet city. Reform in health system management and service provision are useful for promoting accessibility in health services. Therefore, expansion of health coverage, introduction to health insurance scheme, empowerment of urban poor, and ensuring efficient and accountable health service management in public hospital must be ensured for getting adequate health services.

STUDY OF CLINICALAND DEMOGRAPHIC PROFILE OF PATIENTS VISITING A TERTIARY EYE CARE CENTRE ALONG WITH THE EFFECT OF LOCKDOWN DURING COVID-19 PANDEMIC

Aim – To study the clinical and demographic profile of patients visiting a tertiary eye care centre along with the effect of lockdown during Covid-19 pandemic. Material and Methods – This cross-sectional study included patients presenting during the entire lockdown period i.e. 25th March to 31st May, 2020. Records of the patients relating to symptoms, diagnosis and treatment modalities were analysed. Results – A total of 723 patients presented in the ophthalmology department of which 82.43% were in the OPD and 17.57% in the emergency. 60.03% were male and 39.97% were female. In the OPD, 21.81% patients had refractory errors, 12.08% presented with corneal disorders of which viral keratitis was the most common disorder. 10.57% presented with retinal disorders, 8.05% of patients had cataract and 4.69% had glaucoma. During this period 21 emergency surgeries were conducted. Conclusion – As a result of the nationwide lockdown in response to Covid-19 pandemic, there was considerable reduction in patients indicating lesser accessibility of health services to the needy patients. This needs to be addressed by planning delivery of health services in an effective and better way.

Reproduksi Makna Miskin dalam Surat Keterangan Tidak Mampu (SKTM) untuk Pelayanan Kesehatan Masyarakat Miskin Non Kuota di Kabupaten Sidoarjo

A relief letter (SKTM) from Social Service Office of Sidoarjo is a mechanism for non-quota poor people to access health services. The dilemma occurred when the office indicated that 80% of the target users of the letter were inaccurate. Understandings on terms of “poor”in relief letter and by health service providers play an important role in this phenomenon. This study identifies the reproduction of the meaning of poor on non-quota poor health services in Sidoarjo. This was a qualitative approach, conducted in Sidoarjo and Tarik District that had different characteristics to obtain comprehensive results. The structuration theory from Anthony Giddens used to analyze the data findings. The results indicated that poverty for non-quota poor users was interpreted as (i) unemployed conditions, and (ii) inability to meet health needs. Reproduction of “poor” meaning occurred when informants relate it to the accessibility of health services. This term was also reproduced into business and political interests by health officers and government officials at the poor village. Discursive awareness among agents involved in non-quota health services modified the service. Abstrak Surat Keterangan Tidak Mampu (SKTM) dari Dinas Sosial Kabupaten Sidoarjo menjadi sebuah mekanisme bagi masyarakat miskin non kuota untuk mengakses pelayanan kesehatan. Dilema terjadi manakala Dinas Sosial Kabupaten Sidoarjo mengindikasikan bahwa 80% pengguna surat tersebut tidak tepat sasaran. Pemahaman pengguna surat rekomendasi tidak mampu dan penyelenggara pelayanan kesehatan tentang makna miskin memiliki peran penting dalam fenomena tersebut. Penelitian ini berupaya mengidentifikasi reproduksi makna miskin pada pelayanan kesehatan masyarakat miskin non kuota di Kabupaten Sidoarjo. Menggunakan pendekatan kualitatif, penelitian ini dilakukan di Kecamatan Sidoarjo dan Kecamatan Tarik yang memiliki karakteristik berbeda guna memperolah hasil yang komprehensif. Teori Strukturasi dari Anthony Giddens digunakan untuk menganalisis temuan data. Hasil penelitian menemukan bahwa kemiskin bagi pengguna masyarakat miskin non kuota dimaknai sebagai (i) kondisi tanpa pekerjaan, dan (ii) ketidakmampuan memenuhi kebutuhan kesehatan. Reproduksi makna miskin terjadi manakala informan berhubungan dengan aksesibilitas layanan kesehatan. Melalui petugas medis dan aparatur pemerintah desa miskin direproduksi menjadi kepentingan bisnis dan politis. Kesadaran diskursif antar agen yang terlibat dalam pelayanan kesehatan non kuota telah memodifikasi layanan tersebut.

In search of universal health coverage – highlighting the accessibility of health services for students with disabilities in Ghana: a qualitative study

Background: Accessibility to health services for students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health services for students with disabilities. This study, therefore, aims to explore the accessibility of health services for students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results : The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health services. The barriers faced by students with disabilities are unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health services. Conclusion : The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the NHIS scheme should be revised to adequately address the needs of people with disabilities.

ANALYSIS OF CONDITION AND POSSIBILITIES FOR IMPROVING OF FINANCIAL MANAGEMENT OF HEALTHCARE IN BULGARIA

Health is a public good as an economic category, which is why it has no value. The health services are valued because they have direct and indirect costs, which have a certain price. The health services market is the most "deformed" market, and so much effort is being made in Bulgaria to be more regulated. In doing so, the aspiration is to do this through precisely defined rules defined on a centralized principle. The lack of a comprehensive conception of mastering the economic interests of the specific "market" of Bulgarian healthcare equally damages both doctors and patients. The former became traders, and the latter became "buyers" of health. This is happening at a time when Europe speaks of values on which every national health policy must be built: solidarity, accessibility of health services and protection of patients' rights.

The Peculiarities of Civil-Legal Regulation of Transplantation in Ukraine and Europe

In modern realities the issue of the quality and accessibility of health services, the cost of medicines, examinations and treatment in general is being increasingly frequently discussed. The attention is focused on such a narrow surgical field as transplantation, because in Ukraine thousands of patients are waiting in line for organ transplantation and very few operations are performed. The main, most secure and common type of transplantation is the transplantation of organs and tissues from a deceased person, the dead body. Cadaveric transplantation, which is used in most developed countries, is hardly carried out in Ukraine. This is due to the fact that the current regulatory base of Ukraine in the field of transplantation does not fully meet the needs of modern medicine and has many gaps. The aim of donation is a future transplantation (including and in cases of blood transfusion and reproductive cells use). The parts (tissues, organs, their parts, individual cells) extracted (separated) from the body in the process of donation can be used generally in the treatment process in a processed form (blood plasma) or in the original state (fertilized reproductive cells). The detailed analysis of the provisions of the national legal system makes it possible to conclude that, despite the absence of direct regulation of relations concerning organ donation and transplantation as material relations, the legal regulations provide the fundamental provisions, which determine their material nature, and therefore offer opportunities for agreementbased regulation. In our opinion, one of the essential legal means of ensuring the rights of participants in the relations of donation and transplantation can be their agreement-based regulation. The peculiarities of civil-legal regulation of transplantation in Ukraine and Europe are simultaneously analysed; and the grounds of its legitimacy are defined.