Concepts, reflections and applications of social equity: approaches to accessibility to primary goods and services in the region of Flanders, Belgium

Mobility presents a variety of opportunities as it allows users to access locations and services, and to meet people beyond their immediate surroundings. While the concept of mobility primarily focuses on the ease of moving, accessibility delineates the actual potential to participate in out-of-home activities. As a result, accessibility is a complex concept with a multitude of foci. This complexity is presented in the first section, which explains the general concept of accessibility, how it is defined and how it is related to the notion of transport-related exclusion. This section also gives an overview of the body of literature on the measures to determine area-based as well as personal accessibility levels and points out the important contrast between the simple, easy-to-interpret methods, adopted by policy makers and the complex methods preferred by experts. The second section clarifies how the dichotomous relationship between the urban and rural environment is reflected in transport policy that emphasizes on (especially car-based) mobility rather than on accessibility. Furthermore, the environmental and economic points of view are highlighted and the common policy strategies focused on sustainability are illustrated. Subsequently, the shortcomings in the way in which the contemporary debates concerning mobility, sustainability and the social implications of transport planning are conducted, are criticized. Finally, the last part of this section is dedicated to an extensive discussion on the ability of transport policies to, on the one hand, generate spatially as well as temporally uneven accessibility effects that give preference to certain population groups above others, and on the other hand, their ability to strive for a more equitable distribution of transport services amongst the population. The third section proposes two methodologies for measuring transport-related social exclusion implemented in a literature-based case study in Flanders. These studies comprise the following topics: measuring transport gaps by relating the social to the transport disadvantage and measuring modal disparities by comparing accessibility by private and public transport. The former investigates in which areas the provision of the public transport system is not tailored to specific public transport needs. The latter examines the disparity in access by private and public transport in order to highlight the car dependency. Both case studies incorporate the temporal variability in provision through the private and public transport network, as the time-of-day strongly influences accessibility levels

Spatial accessibility and social inclusion: The impact of Portugal's last health reform

Health policies seek to promote access to health care and should provide appropriate geographical accessibility to each demographical functional group. The dispersal demand of health‐careservices and the provision for such services atfixed locations contribute to the growth of inequality intheir access. Therefore, the optimal distribution of health facilities over the space/area can lead toaccessibility improvements and to the mitigation of the social exclusion of the groups considered mostvulnerable. Requiring for such, the use of planning practices joined with accessibility measures. However,the capacities of Geographic Information Systems in determining and evaluating spatial accessibility inhealth system planning have not yet been fully exploited. This paper focuses on health‐care services planningbased on accessibility measures grounded on the network analysis. The case study hinges on mainlandPortugal. Different scenarios were developed to measure and compare impact on the population'saccessibility. It distinguishes itself from other studies of accessibility measures by integrating network data ina spatial accessibility measure: the enhanced two‐stepfloating catchment area. The convenient location forhealth‐care facilities can increase the accessibility standards of the population and consequently reducethe economic and social costs incurred. Recently, the Portuguese government implemented a reform thataimed to improve, namely, the access and equity in meeting with the most urgent patients. It envisaged,in terms of equity, the allocation of 89 emergency network points that ensured more than 90% of thepopulation be within 30 min from any one point in the network. Consequently, several emergency serviceswere closed, namely, in rural areas. This reform highlighted the need to improve the quality of the emergencycare, accessibility to each care facility, and equity in their access. Hence, accessibility measures becomean efficient decision‐making tool, despite its absence in effective practice planning. According to anapplication of this type of measure, it was possible to verify which levels of accessibility were decreased,including the most disadvantaged people, with a larger time of dislocation of 12 min between 2001 and 2011

Spatio-temporal modelling and analysis of spatial accessibility to primary health care: A case study of Bhutan

Both spatial and aspatial dimensions of healthcare system are important in strengthening the healthcare system of any country. Knowing the spatial aspects of healthcare accessibility can help develop proper health policies in planning equitable allocation of health resources across the country. This thesis deals with the modelling of population and spatial accessibility using GIS, and an analysis of spatial and temporal changes in accessibility to healthcare services in Bhutan

Evaluation of a Quality Management Initiative and HIV Ambulatory Services Performance in Thailand

The accomplishment of pilot implementation of the HIVQUAL-T model, an innovative HIV care quality management tool, has led to an authoritative decision to scale up the use of the model nationwide in Thailand. However, the level of implementing this model varies across target hospitals. Some hospitals have fully adopted the model by conducting quality improvement (QI) activities following performance measurement (PM) results while others have partially adopted only PM or have not used this model at all. The differential level of implementation could be a contributing factor accounting for discrepancies in the quality of care across different HIV ambulatory care facilities. A cross-sectional study was conducted by using two main datasets, including Thailand\u27s national HIV care performance results and an online survey of all public hospitals nationwide. A total of 382 hospitals responded to the survey, accounting for a response rate of 50%. A confirmatory factor analysis (CFA) method was performed to examine the validity of latent constructs developed from the diffusion of innovation theory. Structural equation modeling (SEM) approach was employed to investigate the relationship between the determinants of organizational decision-making and their contribution to organizational outcomes, under the context-design-performance framework. Furthermore, using a panel model of hospitals that reported performance results across a 3-year period, the improvement in HIV ambulatory services performance among the adopters was examined. The results indicated that two innovation attributes--relative advantage and simplicity perceived by HIV care practitioners in hospitals--were found to be positively associated with the level of the HIVQUAL-T model implementation. Two structural characteristics--interconnectedness and organizational slack--appeared to be positively associated with the level of model implementation, while rate of adoption in the region also had significant positive contribution. Ultimately, the extensiveness of the HIVQUAL-T model implementation demonstrated a proportionate impact on the variation in hospitals\u27 HIV ambulatory services performance. It was noted that the implementers considerably improved their performance within two years of implementing the model. The study findings imply that adoption is more likely when individual practitioners assess the innovation and find it to be easy to comprehend and operate and also worthwhile to implement. Furthermore, hospitals\u27 decision making is likely influenced by their relations to external environment. The findings suggest more emphasis on individual and hospital-level capacity building for meaningful use of this quality management initiative, accompanied by an adjustment of performance measurement software with valid, reliable, and interpretable indicators

Editorial: Smart cities of the future: Creating tomorrow’s education toward effective skills and career development today

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