Dissertations / Theses: 'Health service availability'

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Sikder, Shegufta Shefa. "Obstetric complications in rural Bangladesh| Risk factors for reported morbidity, determinants of care seeking, and service availability for emergency obstetric care." Thesis, The Johns Hopkins University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3571743.

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Background: In settings such as rural Bangladesh, where the majority of births occur at home, population-based data are lacking on the burden and risk factors for obstetric complications, as well as care-seeking behavior. This dissertation seeks to describe the prevalence and risk factors for obstetric complications, explore factors affecting care seeking for complications, and describe the availability of obstetric care among health facilities in rural Bangladesh.

Methods: We used extant data from a community-randomized maternal micronutrient supplementation trial which ascertained reported morbidities and care seeking among 42,214 pregnant women between 2007 and 2011 in rural northwest Bangladesh. Multivariate multinomial logistic regression was used to analyze the association of biological, socioeconomic, and psychosocial factors with reported obstetric complications and near misses. Multivariate logistic regression of socioeconomic, demographic, perceived need, and service factors on care seeking was performed. Primary data on availability and readiness to provide obstetric services at 14 health facilities was collected through surveys.

Results: Of the 42,214 married women of reproductive age, 73% (n=30,830) were classified as having non-complicated pregnancies, 25% (n=10,380) as having obstetric complications, and 2% (n=1,004) with reported near misses. In multivariate analysis, women's age less than 18 years (Relative Risk Ratio 1.26 95% CI 1.14-1.39), obstetric history of stillbirth or abortion (RRR 1.15 CI 1.07-1.22), and neither partner wanting the pregnancy (RRR 1.33 CI 1.20-1.46) significantly increased the risk of obstetric complications. Out of 9,576 women with data on care seeking, 77% sought any care, with only 23% seeking at least one formal provider. Socioeconomic factors and service factors, such as facility availability of comprehensive obstetric services (OR 1.25 CI 1.16- 1.34), improved care seeking from formal providers. Average facility readiness for emergency obstetric care was 81% in private clinics compared to 67% in public facilities (p=0.045).

Conclusions: These analyses indicate a high burden of obstetric morbidity, with a quarter of women reporting obstetric complications. Policies to reduce early marriage and unmet need for contraception may address risk factors including adolescent pregnancy and unwanted pregnancies. Improvements in socioeconomic factors, coupled with strategies to increase service availability at health facilities, could increase care seeking from formal providers.

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Webb, Bettine Constance. "The availability of data in relation to needs and resources within the School Dental Service, Western Metropolitan Health Region, N.S.W." Thesis, The University of Sydney, 1987. http://hdl.handle.net/2123/4776.

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Agunga, Paul Wekesa. "County Health Leadership and Readiness for Noncommunicable Disease Services." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5298.

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Premature mortality resulting from the growing global burden of noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. The purpose of this study was to investigate whether any relationship exists between leadership practices at the county level and readiness for NCD services in Kenya. Path-goal and adaptive leadership theories were used to guide this quantitative correlational study, using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between the independent variable of leadership practices (annual work planning, therapeutic committees, and supportive supervision), and the dependent variable of NCD readiness (county readiness score). The results indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). This study may be significant to county health leaders in relation to their efforts to ensure proximal access to quality NCD services in Kenya. The results of this study may help to promote the development of capacity-building programs targeting health leadership and prioritization of actions to ensure access to NCD prevention and treatment services at the county level in Kenya.

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Brock, Arlesia Lynn. "The impact of privatization of primary care programs in large county health department in florida." [Tampa, Fla.] : University of South Florida, 2005. http://purl.fcla.edu/fcla/etd/SFE0001214.

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LaRoche, Kathryn J. "The Availability, Accessibility, and Provision of Post-Abortion Support Services in Ontario." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32786.

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In a study we conducted with Ontarian women about their abortion experiences (OAS), one third of participants expressed a desire for post-abortion support. Yet, there is some anecdotal evidence to suggest that organizations offering these services are using judgmental frameworks. In order to rigorously investigate this, we explored what post-abortion support services are offered across the province of Ontario. This multi-methods study included an analysis of OAS data, creating a directory of post-abortion support services in the province, conducting an analysis of how these services represent themselves online, and carrying out mystery client interactions. We found that the majority of organizations offering post-abortion support services in Ontario are crisis pregnancy centers. The services offered at these organizations are built upon frameworks that are both shaming and stigmatizing of abortion experiences. Efforts to increase the online visibility and overall accessibility of non-judgmental, medically accurate post-abortion support services in Ontario appear warranted.

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Cummins, Steven C. J. "Socio-spatial variations in urban food price and availability and their implications for healthy eating." Thesis, University of Glasgow, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250014.

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Day, Chelsi. "Availability and Utilization of Sport Psychology Services for Injured College Athletes." Antioch University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1317223366.

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Nickerson, Jason W. "A Field Evaluation of Tools to Assess the Availability of Essential Health Services in Disrupted Health Systems: Evidence from Haiti and Sudan." Thesis, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30373.

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Background: This thesis presents three research papers that evaluate the current tools and methods used to assess the availability of health resources and services during humanitarian emergencies. Methods: A systematic review of peer-reviewed and grey literature was conducted to locate all known health facilities assessment tools currently in use in low- and middle-income countries. The results of this review were used to generate a framework of essential health facilities assessment domains, representative of seven health systems building blocks. Using this framework, a field-based evaluation of tools used to assess the availability of health resources and services in emergencies in Haiti and the Darfur states of Sudan was conducted. The collected assessment tools from these countries were compared against the framework from the systematic review, as well as the Minimum Standards for Health Action in the Sphere Humanitarian Charter and Minimum Standards in Humanitarian Response, and the Global Health Cluster’s Set of Core Indicators and Benchmarks by Category. A coding system was developed using all of these frameworks that enabled the comparison of the assessments collected in both countries. Field-based interviews were conducted with key informants using a convergent interviewing methodology, to gain perspectives on data collection and the use of evidence in formulating health systems interventions in emergencies. Results: 10 health facility assessments were located in the systematic review of the literature, generating an assessment framework comprised of 41 assessment domains. Of the included assessments, none contained assessment criteria corresponding to all 41 domains, suggesting a need to standardize these assessments based on a structured health systems framework. In Haiti and Sudan, a total of 9 (Haiti, n=8; Sudan, n=1) different assessment tools were located that corresponded to assessments of the availability of health resources and services. Of these, few collected data that could reasonably have corresponded to the different assessment domains of the health facilities assessment framework or the Sphere Standards, nor could many have provided the necessary inputs for calculating the Global Health Cluster’s indicators or benchmarks. The exception to this was the one tool located in Sudan, which fared reasonably well against these criteria. The interviews with participants revealed that while evidence was viewed as important, systematically-collected data were not routinely being integrated into program planning in emergency settings. This was, in part, due to the absence of reliable information or the perceived weaknesses of the data available, but also due uncertainty as to how to best integrate large amounts of health system data into programs. Conclusions: Greater emphasis is needed to ensure that data on the availability and functionality of health services during major emergencies is collected using methodologically-sound approaches, by field staff with expertise in health systems. There is a need to ensure that baseline data on the health system is available at the outside of emergency response, and that humanitarian health interventions are based on reliable evidence of needs and capacities from within the health system.

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Whitener, Louise M. "Using Hongvivatana's model to evaluate health care access : a field study of adolescent women's access to reproductive health care services in rural Missouri counties /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9974703.

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Atuhaire, Lydia. "Barriers and facilitators to uptake of cervical cancer screening among women accessing maternal and child health services in Kampala, Uganda." University of Western Cape, 2013. http://hdl.handle.net/11394/3924.

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Magister Public Health - MPH
The aim of the study was to explore the challenges to uptake of cervical cancer screening among women accessing maternal and child health services at Nsambya Hospital in Kampala, Uganda.

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Damberg, Jonas. "Availability of primary care physicians in nursing homes and home care nursing services and associations with emergency care consumption." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-61585.

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Murphy, Caroline E. "Parental Perceptions of Barriers to Care: An Examination of Rural Appalachian Parents' Expectancies of the Availability, Process, and outcome of Mental Health Services for Elementary School-Aged Children." Ohio : Ohio University, 2005. http://www.ohiolink.edu/etd/view.cgi?ohiou1129068871.

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Moloto, Victor. "Identification, resolution and monitoring of barriers to the availability of essential drugs at primary health care facilities in Lejweleputswa district, Free State Province." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=init_3659_1180441246.

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This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.

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Caicedo, Ceron Margarita. "The Availability and the Use of Basic Services in Relation to the Nutritional Status, Acute Diarrhetic Diseases and Acute Respiratory Infections in Children Under five Years of Age in Three Rural Communities of the Imbabura Province during the 1998-1999 Period." BYU ScholarsArchive, 2000. https://scholarsarchive.byu.edu/etd/5339.

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To a large degree, the political and economic conditions of third world countries influence poverty levels, especially in rural areas. This poverty affects the availability of basic services, such as potable water, refuse elimination, housing, and sewage systems. As a consequence of these deficiencies, more diseases are transmitted through the water and environment. These diseases include acute diarrhea and acute respiratory infections in children younger than five years of age. Consequently, it is important to have available water and sewage elimination to control these diseases among children and the general population.

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Lima, Arnaldo Ribeiro Costa. "Mobilidade do trabalho e disponibilidade de médicos no Brasil." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-07042014-125740/.

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Compreendendo a mobilidade do trabalho como um fenômeno que promove o deslocamento espacial, setorial e profissional de trabalhadores, com o objetivo de o capital explorar força de trabalho e acumular excedente econômico e observando que os médicos no Brasil trabalham de forma particularmente diversificada, transversa e longitudinalmente, em múltiplos sub-empregos, procura-se apreender dimensões da mobilidade da força de trabalho de médicos no sistema brasileiro de serviços de saúde. Com a intenção de contribuir para a compreensão e crítica do fenômeno da disponibilidade desses profissionais, como processo sócio-histórico significante para a implementação do Sistema Único de Saúde, desenvolvem-se táticas de aproximação sucessiva ao empírico da mobilidade do trabalho de médico, em diversidade metodológica, pela integração de métodos quantitativos e qualitativos, utilizando-se de entrevista, pesquisa bibliográfica e análise de documentos e de dados secundários de pesquisas. Apreende-se, além de espacial, setorial e profissional, um deslocamento temporal na mobilidade da força de trabalho de médicos no modo como se dispõe no sistema brasileiro de serviços de saúde. Captura-se o desenvolvimento de estratégias e contra-estratégias de mobilidade, indicando-se que, constituído como um dilema, da falta ou da má distribuição de médicos, o problema culmina tratado muitas vezes de forma derivada, restrita e recalcada, apesar de aludidos os seus condicionantes e determinantes. Colhem-se representações e categorias de pensamento de atores dos sistemas de formação, de gestão de sistema de serviço de saúde e de representação da categoria profissional de médicos sobre possibilidades e limites de interiorização do trabalho médico no Brasil denotativas da fragmentação e segmentação do sistema brasileiro de serviços de saúde. Prestam-se outras contribuições para estudos de epidemiologia, de sociologia do trabalho e de psicologia do trabalho.
Understanding labor mobility as a phenomenon that promotes spatial, sectoral and professional displacement of workers, with the aim of capital exploiting their workforce and accumulating economic surplus, noting that medical doctors working in Brazil do it in a way which is particularly diverse, transverse and longitudinal, in multiple sub-jobs, seeking to grasp the dimensions of mobility of the workforce of medical doctors in the Brazilian system of health services. Aiming to contribute to the understanding and critique the phenomenon of availability of such professionals as a significant socio-historical process for the implementation of the National Universal Health System, developing tactics of successive approximation to the empirical labor mobility of medical, in methodological diversity, by the integration of quantitative and qualitative methods, using interviews, literature review and analysis of documents and secondary data research. Seizing up, beyond spatial, sectoral and professional, a temporal shift in the mobility of the workforce of medical doctors in the way it disposes the Brazilian system of health services. Capture the development of strategies and counter-strategies of mobility, indicating that, constituted as a dilemma, of lack or maldistribution of medical doctors, the problem often culminates being treated derivatively, restricted and repressed, although alluded their condition and determinants. Representations and thought thinking categories of actors of formation systems, management systems of health service and representation of the profession of medical doctors about the possibilities and limits of internalization of medical work in Brazil are gathered denoting the fragmentation and segmentation of the Brazilian health services system. It lends other contributions to epidemiology, sociology of work, psychology of work studies.

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Unwin, MR. "Primary care to emergency department: right service, right time, right place." Thesis, 2021. https://eprints.utas.edu.au/38173/1/Unwin_whole_thesis.pdf.

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Emergency department presentations continue to increase internationally and provide evidence that all is not well for health services and the populations they serve. In Australia, the equivalent of the combined populations of Brisbane and Adelaide presented to emergency departments with non-urgent conditions over a twelve-month period between July 2018 and June 2019. This study aimed to identify the health service requirements of patients presenting to a regional Australian ED with non-urgent conditions, and to translate findings into key recommendations and priorities for future health service planning. An explanatory sequential mixed method was used and involved three phases. The first phase was a descriptive and inferential analysis of seven years of routinely collected ED data to establish a profile of who presented to the ED with non-urgent conditions and when and why they presented. During the seven-year period 54.1% (n=165,399) of presentations were triaged as non-urgent. The second phase used a qualitative approach to conduct interviews with patients (n=9) and general practice staff (n=15). A thematic approach was used to analyse data. The final phase engaged key stakeholders and used a nominal group technique to translate research knowledge into recommendations and priorities for health service provision in Northern Tasmania. This study identified an over-representation in non-urgent ED presentations by young adults and children from the most disadvantaged suburbs, and a significant increase in mental health presentations over a seven-year period. An increasing proportion of presentations was observed to occur outside regular business hours. Interviews and focus groups highlighted a genuine perceived need for urgent care, at times driven by fear regarding symptoms. Patient interviewees did not consider the cost of primary care services to be a driver of their ED presentation; instead they demonstrated an understanding of the health system and identified limited access to primary care services. Service characteristics valued by patients were: clear communication, connection and comfort. In contrast, health professionals believed cost to be a major driver of non-urgent ED attendances and attributed patients with blame. A forum with key stakeholders from health services, academia, local government, community groups and a consumer representative identified key priorities for health service planning targeting local needs. Forum participants concluded that nurse practitioner and community paramedic roles in a primary health care setting could provide the right service at the right time and in the right place for this patient population, thereby reducing ED presentations. Participants identified that the ‘ultimate model’ would be located in the area of greatest need with an ability to provide outreach services and would include an interprofessional approach to health care provision. This service would be community led, driven and designed, and provide extended hours of service, seven days per week. This study provides a high quality example of how the explanatory sequential mixed method can be used to inform health service planning and policy. This method provides a strong framework in establishing the profile of who accesses the ED with non-urgent conditions and when and why they accessed them. Key findings were used to inform recommendations and priorities to address the needs of over-represented patient populations. The method used in this study provides a strong example for researchers internationally, who are working to address population health care needs.

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Maxey, Hannah L. "Understanding the Influence of State Policy Environment on Dental Service Availability, Access, and Oral Health in America's Underserved Communities." Thesis, 2014. http://hdl.handle.net/1805/5993.

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Indiana University-Purdue University Indianapolis (IUPUI)
Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.

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Wilson, John Robert Jr. "Ethics in the service of the rare disease patient: Application of the thought of John Rawls and Paul Ramsey toward the increased availability of orphan drugs." Thesis, 1990. http://hdl.handle.net/1911/13482.

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Persons with rare diseases are frequently unable to obtain suitable pharmacologic treatment. Pharmaceutical companies are not apt to develop compounds for which there is a very small commercial market. Further, drugs for rare diseases are scrutinized by the Food and Drug Administration in the same manner as those for more common diseases--a contingency which, due to the enormous cost of drug research, further discourages profit-driven pharmaceutical companies from developing compounds for rare diseases. John Rawls and Paul Ramsey offer insight into the situation and remedy of the plight of the rare disease patient. Rawls, with his notion of the basic structure of society, offers a framework in which justice dictates that the background institutions of this basic structure be constantly criticized and changed. Ramsey's thought serves the issue with his notion of agape or covenant-care--a concept which calls for the treatment of patients as suffering individuals.

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Gusterman, Teona. "Availability and access to health care for irregular migrants in Greece: a study about changes between 2010 and 2020." Thesis, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-414783.

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Zuma, Sibusiso Memory. "The factors affecting availability of medicines in the Free State District Health Services." Diss., 2013. http://hdl.handle.net/10500/13331.

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The purpose of this study was to identify and explore factors affecting medicine availability within the district health services. A qualitative descriptive, exploratory and contextual research design was followed. The data collection was conducted through two focus group discussions comprising of pharmaceutical managers and district health services managers respectively. The study found that medicine was not consistently available in the various districts, especially in community health centres and primary health clinics. The factors contributing to the non-availability of medicines include challenges with deliveries from Medical Depots, poor medicine stock management, shortage of pharmacists and pharmacist’s assistants in the facilities, lack of the electronic medicine management systems and the separate existence of Pharmaceutical Services and Medical Depot within the province. The study made recommendations on how to improve medicine availability within the district health services.
Health Studies
M.A. (Health Studies)

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Nene, Minenhle Mbuso. "To examine the availability, accessibility and utilization of health care services in a rural area - Ndwedwe." Thesis, 2002. http://hdl.handle.net/10413/10389.

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The study attempts to investigate the availability, accessibility and utilization of health care services in a rural area. The study has been conducted in one of the rural areas (Ndwedwe) in the Province of KwaZulu Natal (Durban) near the town called Verulam. The Ndwedwe area consists of a population of about 170 000 and the number of households is hard even to estimate because of the geographical setting of the area. The study has been conducted at the centre of the entire area called Ndwedwe central w!:lere the Ndwedwe municipality is located. Most of the people spend most of the time in this area because it has most of the services that are needed by the community. The questionnaires administered and the interviews conducted were systematic because in all the sixteen areas, interviews were conducted (at least two ihterview encounters in one area consisting of the entire Ndwedwe area) and questionnaires were administered the same way. The findings show that the majority of people in the Ndwedwe area do not have enough health care service institutions and the very services are not equally and evenly distributed amongst areas that constitute the entire Ndwedwe area.
Thesis (M.A.)-University of Durban-Westville, 2002

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Yiech, Deng Chuol. "Assessment of the availability of public health services in humanitarian responses in Gambella, Ethiopia." Thesis, 2020. http://hdl.handle.net/10500/27511.

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The purpose of the research was to assess the availability of public health services in response to humanitarian crises in Gambella, Ethiopia. This informed the development of a public health service protocol for humanitarian emergency responses in Ethiopia. The objectives of the study were explored and identify current humanitarian health emergency needs and responses, describe the availability of public health services required for humanitarian emergency responses, study and critically analyse different humanitarian responses in respect of health care services and related protocols in other countries, develop a context-specific and needs-based protocol for humanitarian emergency responses in Gambella, Ethiopia, clarify the policy and programme implications of such a protocol. A mixed-method research design was used to conduct the study. Data were collected from 32 health facilities to assess the availability of required resources and public health services. A checklist and in-depth interview guide were used to collect the data. The quantitative data were analysed using simple descriptive statistics using frequency distribution tables and graphs. Thematic analysis was employed to analyse the qualitative data. The study revealed a lack of resources which threatened the availability of public health services in humanitarian emergencies. The ever-increasing number of refugees overstretched the limited resources, leading to stockouts of medicines, other health commodities and equipment. The absence of emergency preparedness, poor coordination of services, coupled with a lack of integration of services exacerbated public health service delivery. The study findings informed the development of a public health service protocol for humanitarian responses in Ethiopia. The study further recommended further research on other factors that might affect humanitarian responses and coordination.
Health Studies
Ph. D. (Public Health)

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Platt, Jennica. "Geographic Access to Breast Reconstruction and the Influence of Plastic Surgeon Availability." Thesis, 2013. http://hdl.handle.net/1807/43301.

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Background: We evaluated geographic patterns for immediate and delayed breast reconstruction (IBR, DBR) in Ontario. The influence of plastic surgeon availability on rates and service provision was determined. Methods: We examined IBR and DBR from 2002 through 2011 across Ontario counties. Regional availability of plastic surgeons was described. Geographic patterns were examined using funnel plots, random-effects models and migration indices. Results: Over ½ Ontario counties have no plastic surgeons. IBR ranged from 0 to 21.5% across counties and differences in plastic surgeon availability explained 41% of variation (p < 0.0001). For DBR there was less variation. 5/45 counties performed ¾ of BR, however rates among local residents were not highest. Interpretation: Nearly 1/3 of the population has limited access to plastic surgeons, contributing to low rates of BR. Geographic access is a major determinant of IBR but is less important for DBR, however service provision for both was highly regionalized.

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Tsuruda, Kaitlyn. "EVALUATING THE EFFECTS OF ORGANIZATIONAL POLICIES ON SURGEONS’ AVAILABILITY TO OPERATE: A COMPUTER SIMULATION APPROACH." 2011. http://hdl.handle.net/10222/14368.

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Surgical services contribute to a large proportion of a hospital’s costs and revenues thus it is important to understand key performance drivers so that resources can be distributed in an informed way. Organizational policies can affect the performance of the peri-operative process, however, there is a lack of knowledge within the health services literature regarding how the organizational policies of a surgical service affect surgeons’ availability to perform operations. Additionally, simulation-based research has largely focused on operating room planning and scheduling, not on how surgeons’ operating time may be affected by organizational policies. The objective of this simulation study was to estimate the effects of organizational policies on surgeons’ availability to operate in the context of cardiac surgical care. The major finding was that surgeons’ availability to operate declines if surgeons are not permitted to be on-call and scheduled in the OR for non-emergency operations on the same day.

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Ntoa, Ntefeleng. "An examination of the availability and accessibility of health care services in the rural area of Shongweni." Thesis, 2004. http://hdl.handle.net/10413/4061.

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The study examines the availability and accessibility of health care services in rural areas in relation to the right to health. The area that has been selected for the purpose of this study is the Shongweni area in the Province of KwaZulu - Natal. The area is situated on the border of Mpumalanga and Durban Region under the Outer - West City Council.
Thesis (LL.M.)-University of Durban-Westville, 2004.

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Ghosheh, Mona R. "Organizational cultural competence and the availability of outreach services for racial and ethnic minorities in university counseling centers." 2012. http://liblink.bsu.edu/uhtbin/catkey/1697792.

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Outreach is recommended as an intervention for racial and ethnic minorities who underutilize traditional mental health services (e.g., Brinson & Kottler, 1995). Yet, the availability of outreach services at university counseling centers for students of color has not been studied. In addition, no study has examined factors influencing the availability of outreach services for racial and ethnic minorities. The primary purpose of the current study was to investigate the availability of outreach for racial and ethnic minorities and how these services are influenced by institution size, staff size, institution type, accreditation, and organizational cultural competence. One hundred and fifty one counseling center directors completed an online survey. It was hypothesized that counseling centers’ organizational cultural competence would predict the availability of outreach services for racial and ethnic minorities beyond that of institution size, staff size, institution type, and accreditation. The results supported this hypothesis. Among the variables examined, organizational cultural competence was the greatest predictor of the availability of outreach for students of color. The results suggested that counseling centers with greater levels of organizational cultural competency also had a greater availability of outreach services for students of color. The implications of these findings for theory, research, and practice are discussed.
Department of Counseling Psychology and Guidance Services

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Tshibangu, Delphin-Cyrille. "The effects of availability of reproductive health services on the contraceptive use and method choice in the city of Tshwane Metropolitan Municipality." Thesis, 2009. http://hdl.handle.net/10539/6112.

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ABSTRACT This study is the first of a series of community-based surveys that the City of Tshwane Metropolitan Municipality (CTMM) has planned to conduct in the next 15 years to fulfill its provincial mandate (being the provider of primary health care services) in accordance with the Gauteng District Health Services Act (Act No 8 of 2000)1. The study determined the prevalence rate of contraceptive use and method choice, and the effects of the availability of reproductive health services on contraceptive use and method choice in the CTMM in 2004. The study used a descriptive cross-sectional population-based study design and a sample of 3, 547 women of childbearing age (15-49 years) using a multi-stage cluster sampling with probability proportional to size to determine these effects. A modified 1998 SADHS questionnaire helped to collect information on selected individuals, programmes and district explanatory variables from women living in the four health sub-districts and data were used in three B (4 variables), C (six variables) and D (eight variables) unconditional binary logistic regression models and a multinomial logistic model to estimate their effects (odds ratios and pvalue at 5% level) on contraceptive use and method choice. The selection of these variables is based on the conceptual framework that recognizes that contraceptive use or method choice is the consequence of service utilization, which, in turn, is influenced by individual, service/programme and community factors2,3. The availability of reproductive health services was measured by the presence or absence of the supply source of contraceptive methods in a district. After controlling for the effects of individual (social and demographic) variables, none of the programmatic variables was independently associated with contraceptive use. By contrast, district/place of residence predictor was associated with reduced odds of contraceptive use and with reduced odds of condom, injection and IUD’s choice against pill in all the models and districts, respectively. In terms of the source of first information on contraceptive methods and the differences between IUD and injection, the study shows that nurses (odds ratio, 1.80, p<0.05) are more likely than mothers to be the providers of information on IUD while physicians (odds ratio, 0.65, p<0.05) are shown to be less likely than mothers to be the providers of information on injection as opposed to the pill. The private sector ( odds ratio, 2.12, p<0.01) is shown to be more likely than the public sector to be the supply source of IUD methods rather than the pill, and also more likely (odds ratio, 1.97, p<0.01) than the public sector to be the supply source of IUD instead of injection. Private pharmacies (odds ratio, 2.25, p<0.05) are more likely than the public sector to supply condoms rather than the pill. The presence or absence of reproductive health services in a district was significantly associated with reduced odds of both contraceptive use and choice of condom, injection and IUD methods against pill. This may be attributable to women’s willingness to travel outside their place of residence to get their preferred method. Thus availability of reproductive health services in the district seems not to have an important effect on use and choice of modern contraception in the City of Tshwane in 2004.

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28

Eunice, Bosede Avong. "Prescribing practices in the social health insurance programme at secondary hospitals in the federal capital territory, Abuja, Nigeria." Thesis, 2012. http://hdl.handle.net/11394/3956.

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Master of Public Health - MPH
The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

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Prophète, Félix. "Équité d’utilisation des services de santé et de disponibilité des ressources en matière de santé dans la province de Québec." Thèse, 2012. http://hdl.handle.net/1866/9677.

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Objectif : L’objectif général de cette étude est de comprendre en quoi l’utilisation des services de santé et de disponibilité des ressources en santé au Québec sont équitables. Méthodes : De type transversal et corrélationnel, cette étude intéresse les 95 territoires CSSS du Québec, et couvre les années 2006-2007 et 2008-2009. L’indice de défavorisation matérielle et sociale de Pampalon est mis en lien avec deux séries de variables, soit celles d’utilisation des services par CSSS (services hospitaliers; services médicaux; services CLSC) et celles de disponibilité des ressources (capacité financière; capacité matérielle, capacité humaine; viabilité). Pour ce faire, des analyses de variance ont été effectuées. Le modèle intégrateur de la performance des services de santé EGIPSS et celui de l’utilisation des services de santé de Donabedian servent de cadre d’analyse. Résultats : L’utilisation des services de santé est équitable en ce qui concerne la défavorisation matérielle, mais pas en ce qui a trait à la défavorisation sociale. L’utilisation des services médicaux dispensés par les omnipraticiens est plus élevée chez les populations les plus favorisées socialement comparativement aux populations les plus défavorisées. Toutefois, l’utilisation des médecins spécialistes est plus équitable que celle des omnipraticiens, cela, chez les populations défavorisées autant matériellement que socialement. Les hospitalisations évitables sont plus élevées chez les populations les défavorisées socialement comparativement aux populations les plus favorisées. En termes de disponibilité des ressources, les populations défavorisées disposent de plus de ressources que les plus favorisées, sauf en ce qui concerne la répartition du personnel. Conclusion : En général, il existe très peu d’iniquités dans l’utilisation des services de santé au Québec. Par ailleurs, la disponibilité des ressources en santé est relativement équitable au Québec, exception faite de la disponibilité du personnel.
Objectives: The general objective of this study is to understand in what the use of health services and the availability of health resources in Quebec are fair. Methods: This cross-sectional and corelational study interests the 95 territories CSSS of Quebec, and covers the years 2006-2007 and 2008-2009. The material and social deprivation index of Pampalon is put in connection with two series of variables, such those of the use of the services by CSSS (hospital services; medical services; CLSC services) and those of availability of the resources (financial capacity; material capacity, human capacity; viability). To do it, analyses of variance were made. The integrative model of the health service performance (EGIPSS) and that of the use of the health services of Donabedian serve as frame of analysis. Results: The use of health services is fair as regards the material deprivation, but not in what concerned the social deprivation. The use of medical services dispensed by the general practitioners is more raised at the population the most favored socially compared with the most disadvantaged population. However, the use of the specialists is fairer than that of the general practitioners, it, for the populations disadvantaged so materially as socially. The avoidable hospitalizations are more raised at the population the most disadvantaged socially compared with the most favored. In terms of the availability of resources, the disadvantaged populations have more resources than the most favored populations. Conclusion: Generally, there are very few inequities in the use of health services in Quebec. Besides, the availability of the resources regarding health is relatively fair in Quebec, exception made by the distribution of the staff.

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Dissertations / Theses on the topic 'Health service availability'

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