Closing the Gap: Increasing Access and Equity
Introduction
International Nurses Day will be celebrated around the world on May 12, 2011, and focuses mainlyupon the importance of the right toequitable access to healthcare services. This year’s theme is “Closing the Gap: Increasing Access and Equity.”
Official Date
May 12, 2011, corresponding to Jamadi Thani 9, 1432 H.
Targeted Categories
- Nurses and nursing technicians
- Organizations and health institutions
- Healthcare decision-makers
Objectives
- Understanding “access” and “equity” in healthcare
- Recognizing the burden of inequality
- Measuring access and equity
- Barriers to access and equity
- Increasing access and equity
- Defining ways in which nurses can enhanceaccess and equity
Logo (2011)
Related Sites
- www.who.int
- www.icn.ch/indkit2010.htm
International Nurses Day 2011
Closing The Gap: Increasing Access and Equity
Access: refers to the ability to obtain an item or service at the required time.
Key Elements of Access to Health Services include:
- Service availability
- Use of available services by the population
- Services provided reflecting the service needs and preferences of the population groups
- Provided services effectiveness whether the desired treatment or service outcomes is achieved
- Equity, which refers to differences in the access across different groups
Barriers to Access Can Include:
- Lake of capacity and availability: i.e. long waiting lists for particular types of treatment, shortages of infrastructure or staff, or lack of services at the place or time they are needed.
- Cost: Full or partial payment for many types of health services remains the norm in many countries, which can be a significant barrier to the poor.
- Language and culture: making provision for members of the community to access health services in their community language is an important part of making health care accessible and effective. Similarly, failure to cater for different culture norms can adversely impact on the willingness of people to seek help as well as the effectiveness of treatment.
- Lack of information and Knowledge: includes access to information about one’s own health, about prevention strategies and approaches, and about the kind of services that are available.
- Mobility and migration: mobile populations may find it difficult to identify and access services. Particularly if administrative barriers exist.
- Employment: lack of employment can limit access to health services.
Indicators of Access and Use of Health Services
- Health insurance coverage
- Health care utilization in relation to different services
- Measures of unmet care needs
Leading indicators that can be used to measure inequities in access to health care services :
- Related indicators to life expectancy and mortality
- Related indicators to morbidity and disease
- Composite indicators which include both these types of information
Disadvantages of InequalityThere are strike disparities in population health and access to services across the world. Therefore, it is important to provide equal access to health services. Millennium development goal targets focus on human rights that every individual around the world should be able to enjoy- freedom from extreme poverty and hunger; quality education, productive and decent employment, good health and shelter, reduce child mortality, combat HIV/AIDS, improve maternal health ; the right of women to give birth without risking their lives; and promote gender equality.
Health and Millennium Development
Millennium development aims to reduce child mortality, combat HIV/AIDS and Tuberculosis. However, there are other challenges of access to health services, such as shortage of well-trained nurses, insufficient responses by governments to the health needs of their populations and the need of greater cooperation between governmental and private sectors.
- Gender:
More than 350,000 women die from preventable complications related to pregnancy and childbirth. Gender equality and improving access to services for women is preconditions for overcoming poverty. Therefore, governments should achieve millennium development goals to save the lives of four million children and about 190,000 women in 2015 alone.
- Ethnicity and Culture:
There is a wide spread evidence from across the world that ethnicity and culture can have a significant influence on both the accessibilities of health services and the quality of care that is provided by those services in order to provide effective services to people from different cultures. Shortage in services delivery may lead to lack of knowledge about traditional remedies and possible harmful interactions; and diagnostic errors resulting from poor communication. As well as ineffective communication, whether because of language difficulties or differing interpretations or understanding which participate effectively in decision making regarding care and treatment.
- Socio-economic Status:
The poor experience significant barriers to health care including limited purchasing power, lower rates of health insurance, lower health literacy and often live in slums or remote or rural areas which are often underserved by health systems and experience shortage of health professionals. In addition of unhealthy habits which are also associated with social exclusion, with higher rates of obesity and smoking, and higher risk of developing a drug addiction. Living conditions in poor countries is also included, where inadequate housing, poor nutrition, lack of safe drinking water also contribute to disease spreading.
- Geographical Location:
Considered a significant factor in access to services and often co-exist with other social factors which contribute to poor health services.
- Education Status:
There is a correlation between educational attainment and health status, as well as higher costs for health care. Higher levels of education is also associated with better ability to access complex health care services, as well as participating in preventative health care activities such as screening programs.
- Disability:
Although people with disabilities tend to have a high level of contact with health systems and services, there is evidence that many disabled people have difficulty accessing care that is appropriate to their needs.
- Diet and Nutrition:
Diet and nutrition have a significant impact on health and a close relationship with socioeconomic status in both developing and developed countries. In developed countries, increasing consumption of foods high in fat and energy has led to obesity. While people in less developed countries, suffers from inadequate nutrition, particularly among children and pregnant women which lead to lifelong health deficits.
Barriers to Access and Equity
Expenditures on health services varies widely across the world, which has a direct impact on the provision of services across the health care spectrum. The way in which the available funds are distributed contributes greatly in access to health expenditures per capita.
Human Resources
Health professionals around the world are unevenly distributed. Health workers density varies within and across regions. In addition, there are a large variations in the skill mix of health providers. During 2007, the number of nurses and midwives per 1000 population was only 0.2 in Mali, while it was 16.33 in Norway. The ratio of nurses to doctors ranges widely from nearly 8:1 in Africa to 1.5:1 in the Western Pacific Region (World Health Organization, 2009).
Shortage of nurses and other health human resources causes a heavy barrier to appropriate access to health services in many parts of the world. The World Health Organization has recently released global policy recommendations on increasing access to health workers in remote and rural areas through improved retention in the areas of education, regulation, financial incentives and personal and professional support are outlined.
Nursing Enhancing Access and Equity
- Nurses promotes an environment in which the human rights, values, customs and beliefs of the individual, family and community are respected.
- Nurses shares with society the responsibility for initiating and supporting action to meet public health and social needs, especially those of vulnerable population.
- Nurses participates in creating safe, equitable social and economic working conditions in nursing.
Training and Skills Development for Nursing Effective training, skills development and ongoing learning development are needed to make nurses able to deliver the accessible care which promotes equity and is free of discrimination. It is also important that managers, including nurses managers, equip their employees with information and training appropriate to the needs and preferences of the local community.
Cultural Competency
It is important that workforce must be culturally competent to increase the utilization of health services for all community members. Also helps improve quality of service by improving the patient experience and communication between health service providers and service users.
Developing Roles and Flexibility
The developing of new roles for nurses are proven to be a significant strategy to improve access to many services, as well as increasing the role and deployment of clinical nurse specialists and practitioners which contributes greatly in upgrading health care quality and reducing organizational costs.
Lobbying, Advocacy and Policy Development
Nurses play a major role in policy development through developing analysis, advocacy and research, especially within the domains of health services delivery and restructuring. Thus, lobbying and advocacy are a key part of nursing’s role in addressing issues such as equity and access, and involve the development of a different skill set and knowledge base. Therefore, nurses education is beginning to reflect this need, with the introduction of graduate courses which seek to build the skills needed for nurses to engage effectively in public policy development.
Related Links:
- www.who.int
- www.icn.ch/indkit2010.htm