Migration Flows through the Lens of Human Resource Ageing

Background: Ageing and shrinking of the European population influence the shrinking of central places and the hinterland of cities in a spatial structure. Migration also influences the shrinking or growing of spatial units. Various factors influence migration and, thus, spatial units\u27 demographic, social and economic stability. The age structure of citizens in a spatial unit may change not only due to population ageing but also because these factors influence the migration flows of different cohorts differently, which has not been studied so far. Objectives: We used data on internal migration between Slovenian municipalities in 2018 and 2019 to develop a cohort-based spatial interaction model to estimate future inter-municipal migration. Approach: In a spatial interaction model, we analyzed differences in the attractiveness and stickiness of municipalities for different cohorts, focusing on those over 65 who may wish to prolong their working status. We also tried to answer the question of how to mitigate shrinkage processes in spatial units by investigating the potential to contribute to the social value of communities. Results: The study\u27s results show that the 65+ cohorts do not have the same preferences regarding the attractiveness and stickiness factors as younger migrants. Conclusions: The results of our study could contribute to better decisions at the national, regional, and/or local level when designing strategies for regional, urban, and/or rural development, exploring the best solutions for long-term care, and investing in appropriate networks, or considering the revitalization of rural municipalities

Maternal health service utilisation in Ethiopia : a secondary analysis of the Ethiopian demographic and health survey data

Ethiopia is the second-most populous nation in Africa next to Nigeria, with an estimated population of 110 million. The country has one of the highest maternal mortality rates globally, with 412 deaths recorded in 2019 per 100,000 live births. Improving maternal and newborn health care is a priority of the Sustainable Development Goals (SDGs). Evidence suggests that the utilisation of mainstream maternal health services (antenatal, delivery and postnatal) has a significant effect on the reduction of death and morbidity through early detection and management of potential complications. Studies that have examined the utilisation of Ethiopian maternal health services have had small sample sizes and covered very small geographical areas. Therefore, the representativeness of these studies and the national generalisability of the findings are questionable. Based on the absence of research, this study used the four rounds of the Ethiopian Demographic and Health Survey (EDHS), a nationally representative and relatively large sample size study, to produce more rigorous national estimates for analysis of the utilisation of Ethiopian maternal health services. These estimates include 20-year trends of antenatal care (ANC), skilled delivery and postnatal care (PNC) service utilisation and its influencing factors. The study found that although ANC, skilled delivery and PNC service utilisation showed an increasing trend from 2000 to 2016, skilled delivery and PNC remained low. In addition, the study revealed an increasing trend in the use of traditional birth attendants (TBAs) during childbirth. The study also identified several factors across the four levels of Andersen’s health behaviour model that affect Ethiopian women’s utilisation of maternal health services. The study also identified that need factors, such as birth spacing intentions and contraceptive use, and enabling factors, such as distance to a health facility, are statistically significant factors affecting engagement with maternal health care. The findings of this study emphasise that increasing access to quality maternal health services, improving the continuum of ANC, skilled delivery and PNC service engagements and transitioning from birth with a TBA to birth with a skilled birth attendant are necessary to ensure reproductive age women in Ethiopia have maternal health care that satisfies their needs and aspirations and improves care access experiences. This research is critical to inform policy decision-making to improve maternal health in Ethiopia by achieving the SDGs of reducing maternal mortality to below 70 per 100,000 live births by 2030

Health systems factors that impact on access to maternal services for women with disabilities in sub-Saharan Africa: a systematic review

Includes bibliographical referencesMaternal mortality is an enormous global challenge that is most prevalent in sub-Saharan Africa (SSA). Its prevalence in the SSA region has been attributed to inadequate access to maternal services (MHS) amongst the poor and rural women. In an attempt to improve access to maternal services, women with disabilities (WWDs) have generally been neglected. Little is known about the health systems factors that facilitate or hinder access to MHS for WWDs. However, available studies for women in general in SSA, examining health systems determinants of access to MHS, utilise the silo approach thereby providing fragmented and ineffective solutions to maternal mortality. Globally, taking a comprehensive health systems approach to understand the full range and interconnectedness of health factors is now recognised as crucial in understanding and planning complex health problems such as access to MHS. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on the health systems factors that impact on access to MHS for WWDs in SSA. This dissertation comprises three sections, namely Part A, Part B and Part C. Part A reviews the Protocol; it presents the background and the qualitative systematic review methodology that is utilised in this study. A systematic search of five data bases is outlined and inclusion and exclusion criteria set out to select the suitable tool. A data extraction tool is designed to summarise the studies in a common format and to facilitate synthesis and coherent presentation of data. Part B is the review of existing empirical literature on access to MHS for both women in general SSA and for WWDs globally. Theoretical frameworks of access to health care services and health systems frameworks are also presented in this section. Furthermore, Part B provides the background on why access to MHS for WWDs is important. This section explores how health systems approach can be adopted to reveal the factors that impact on access to MHS; it links the complex systems framework to the availability, accessibility, acceptability and quality framework. Part C is a complete systematic review journal manuscript. The background of the study and methodology are described. This section also includes the findings from the systematic review of original journal articles published in English from 2000 to 2014 that report empirical findings on health systems factors that impact on access to MHS WWDs in SSA

Contributions to the study and modeling of knowledge development systems

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The impact of community based health insurance in health service Utilization in Tigray: A Case of kilte Awlaelo woreda

Health insurance is among the solutions promoted in developing countries since 1990s to improve access to health care services because it avoids direct payments of fees by patients and spread the financial risk among all the insured. Community based health insurance is an emerging and promising concept which addresses health care challenges faced in particular by the rural poor and workers of informal sector. Moving away from out of pocket (OOP) payments for health care at the time of use to prepayment through health insurance is an important step towards financial hardships associated with paying for health services. Ethiopia is a low income country with more of health spending out of pocket payment by households. Community based health insurance was introduced in Ethiopia in 2010.It covers only the rural community and informal sectors. This paper evaluates the impact of community based health insurance on health service utilization by providing financial protection in woreda kilteawlaelo for these rural community and informal sector workers. The insurance coverage increased access to public facility services. The insured are also better protected from large financial burden due to health expenditures than the uninsured .The study suggests that more attention needs to be paid to expanding insurance coverage and setting an appropriate benefit

Socioeconomic Disparities in North Carolina Communities: Issues of Access and Quality of Licensed Child Care.

The purpose of the current study was to examine the relationship between child care program quality and the socioeconomic contexts of the communities in which they operate. The sample, which included nearly all licensed child care providers in North Carolina in 2008, resulted in 6882 programs nested within 619 zip codes and 78 counties. The cross-sectional design integrated data from multiple sources. Child care program characteristics, including rated program quality, were acquired from the North Carolina Division of Child Development. Data from the U.S. Census Bureau was used to measure socioeconomic characteristics of communities at the zip code level. Data from the North Carolina State Head Start Collaboration Office, North Carolina Office of School Readiness, and the North Carolina Division of Child Development were incorporated to examine program funding and subsidy levels from various sources. Data from the North Carolina Partnership for Children were used to identify quality enhancement funds at the county level. Multi-level modeling was utilized to examine the nested data structure of child care programs within communities. Child care quality varied across communities and program quality was modestly correlated when programs were in closer proximity. Program level characteristics, as well as community level socioeconomics were both related to differential quality among child care programs, suggesting that access to high quality child care varies across community contexts

First International Nursing Conference Oman Innovations in Nursing Education and Practice Leading to Quality Care Sultan Qaboos University, Oman, 28–29th November 2011

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