Background: Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers’ quality of life. This study describes residents’ access to health and factors associated with the use of healthcarefacilities. Methods: Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected. Results: Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1%) or hospitals (33.1%). Residents’ age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly ( p < 0.05) associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2%) nor transportation to health facilities was a problem (74.1%). Conclusion: Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend. Keywords: Slum dwellers, health, access, Sodom and Gomorra, Ghana

/pdf/access-to-health-in-city-slum-dwellers-the-case-of-sodom-and-45qe5059jj.pdf

Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana

Sociology has a long history of researching health, yet its theorisation of the health system, as a system or structured set of interlinked practices and institutions, has more recently been neglected. This stands in contrast to the prominence of the term in the policy literature. The importance of the concept of a system is demonstrated through a brief historical examination of the conceptual apparatus available within the discipline, beginning with the work of Talcott Parsons. It is proposed that the under-theorisation of the term makes it difficult to explain social action, specifically how social action might be shaped by the structures of the social system, and indeed, how social action might influence, and bring about change in the system itself. The paper proposes Bourdieu’s concept of the field as an appropriate replacement, demonstrating its greater utility for theorising the role of social structure in shaping healthcare practices and for modelling the healthcare sector itself.

Envisaging the healthcare sector as a field: moving from Talcott Parsons to Pierre Bourdieu

Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient’s social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.

/pdf/a-realist-synthesis-of-cross-border-patient-movement-from-4c8vtwrhi3.pdf

A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries.

Background
Informal workers often face considerable risks and vulnerabilities as a consequence of their work and employment conditions. The purpose of this study was to examine the interplay between the experience of informal work and access to health, using as an example, female beer promoters employed in the informal economy, in the Lao People’s Democratic Republic.

https://link.springer.com/content/pdf/10.1186%2Fs12939-016-0352-6.pdf

Informal workers and access to healthcare: a qualitative study of facilitators and barriers to accessing healthcare for beer promoters in the Lao People’s Democratic Republic

The Micro-Dynamics of Health and Education Provision in the Slums of Nairobi.

Although quality health facilities in Mumbai and Pune are plenty, slum dwellers do not benefit fully from these. Next to financial barriers, low quality treatment and discrimination form major hurdles to entering public care. A lot of them prefer to buy services from ill-qualified private providers. Without social protection in health (SPH), their predicament often boils down to the uneasy choice between forgoing treatment and risking impoverishment. Currently, some SPH interventions try to protect poor urbanites and increase their access to quality care. This article provides more insight into the health service encounter experienced by female slum dwellers. Using data from focus group discussions with members of three SPH interventions and in-depth interviews with providers, challenges faced by the women during their health seeking process are discussed. By using Bourdieu's theoretical concepts on field, capitals and habitus, this study shows that a more subtle reproduction of social inequities and domination in the medical field forces slum dwellers to either forgo treatment, buy ineffective care from private providers, or passively accept the abuse in the public sector. These insights demonstrate the need for transformative SPH interventions to address the power imbalances in society that create and sustain the social vulnerability of poor people when seeking health.

https://link.springer.com/content/pdf/10.1057%2Fsth.2011.18.pdf

Improving access to quality care for female slum dwellers in urban Maharashtra, India : researching the need for transformative social protection in health

Nilangi Sardeshpande

Papers

Improving access to quality care for female slum dwellers in urban Maharashtra, India : researching the need for transformative social protection in health