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Access to Public Health Services and Challenges to Healthcare Management
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Access to Public Health Services and Challenges to Healthcare Management

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences".

Deadline for manuscript submissions: closed (30 June 2025) | Viewed by 5013

Special Issue Editors

Dr. Isabella Piassi Dias Godói

E-Mail Website
Guest Editor
Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Macaé 27930-560, Brazil
Interests: public health; access to public health services; healthcare management; health technology assessment; health economic analysis
Dr. Carlos Podalirio Borges de Almeida

E-Mail Website
Guest Editor
Faculty of Public Health, Federal University of Sul e Sudeste do Pará, Marabá 68507-590, Brazil
Interests: public health; TB illness experiences; infectious disease epidemiology; inequities in health; global health

Special Issue Information

Dear Colleagues,

It is with great pleasure that we present this Special Issue of the International Journal of Environmental Research and Public Health, contributing discussions and reflections on “Access to Public Health Services and Challenges to Healthcare Management”.

According to the World Health Organization (WHO), the health system needs to offer preventive, promotive, curative, and rehabilitative interventions through a combination of public health actions to the population. It is essential to reinforce that the actions of the health system should be responsive and financially fair while treating people respectfully. Additionally, a health system needs staff, funds, information, and overall guidance and direction to function. The WHO considers that few countries have systems that can monitor service delivery and that data on population access to essential services are limited. In this context, it is indispensable for countries to develop strategies to better assess aspects such as the accessibility and quality of health services offered to the population, to contribute to health monitoring and the planning process in the healthcare management scenario.

In this Special Issue, we aim to collect contributions that investigate the perceptions, evaluations, and analyses associated with access to public health services. We look forward to receiving insightful contributions, both qualitative and quantitative studies, regarding emerging issues in social medicine and healthcare management. We strongly encourage the submission of papers from middle- and low-income countries, especially those with a public health system, to better demonstrate the various challenges in healthcare management.

Dr. Isabella Piassi Dias Godói
Dr. Carlos Podalirio Borges de Almeida
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • access to public health services
  • quality of public health services
  • social control
  • healthcare management

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Published Papers (6 papers)

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Research

26 pages, 659 KiB  
Article
Predictors of Health-Workforce Job Satisfaction in Primary Care Settings: Insights from a Cross-Sectional Multi-Country Study in Eight African Countries
by Samuel Muhula, Yvonne Opanga, Saida Kassim, Lazarus Odeny, Richard Zule Mbewe, Beverlyne Akoth, Mable Jerop, Lizah Nyawira, Ibrahima Gueye, Richard Kiplimo, Thom Salamba, Jackline Kiarie and George Kimathi
Int. J. Environ. Res. Public Health 2025, 22(7), 1108; https://doi.org/10.3390/ijerph22071108 - 15 Jul 2025
Viewed by 350
Abstract
Job satisfaction in sub-Saharan Africa is crucial as it directly impacts employee productivity, retention, and overall economic growth, fostering a motivated workforce that drives regional development. In sub–Saharan Africa, poor remuneration, limited professional development opportunities, and inadequate working conditions impact satisfaction. This study [...] Read more.
Job satisfaction in sub-Saharan Africa is crucial as it directly impacts employee productivity, retention, and overall economic growth, fostering a motivated workforce that drives regional development. In sub–Saharan Africa, poor remuneration, limited professional development opportunities, and inadequate working conditions impact satisfaction. This study examined job-satisfaction predictors among health workers in primary healthcare settings across eight countries: Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda, and Zambia. A cross-sectional study surveyed 1711 health workers, assessing five dimensions: employer–2employee relationships, remuneration and recognition, professional development, physical work environment, and supportive supervision. The study was conducted from October 2023 to March 2024. The job-satisfaction assessment tool was adopted from a validated tool originally developed for use in low-income healthcare settings. The tool was reviewed by staff from all the country offices to ensure contextual relevance and organization alignment. The responses were measured on a five-point Likert scale: 0: Not applicable, 1: Very dissatisfied, 2: Dissatisfied, 3: Neutral, 4: Satisfied, and 5: Very satisfied. The analysis employed descriptive and multivariable regression methods. Job satisfaction varied significantly by country. Satisfaction with the employer–employee relationship was highest in Zambia (80%) and lowest in Tanzania (16%). Remuneration satisfaction was highest in Senegal (63%) and Zambia (49%), while it was very low in Malawi (9.8%) and Ethiopia (2.3%). Overall, 44% of respondents were satisfied with their professional development, with Uganda leading (62%) and Ethiopia having the lowest satisfaction level (29%). Satisfaction with the physical environment was at 27%, with Uganda at 40% and Kenya at 12%. Satisfaction with supervisory support stood at 62%, with Zambia at 73% and Ethiopia at 30%. Key predictors of job satisfaction included a strong employer–employee relationships (OR = 2.20, p < 0.001), fair remuneration (OR = 1.59, p = 0.002), conducive work environments (OR = 1.71, p < 0.001), and supervisory support (OR = 3.58, p < 0.001. Improving the job satisfaction, retention, and performance of health workers in sub-Saharan Africa requires targeted interventions in employer–employee relationships, fair compensation, supportive supervision, and working conditions. Strategies must be tailored to each country’s unique challenges, as one-size-fits-all solutions may not be effective. Policymakers should prioritize these factors to build a motivated, resilient workforce, with ongoing research and monitoring essential to ensure sustained progress and improved healthcare delivery. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
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15 pages, 3904 KiB  
Article
Forecasting the Regional Demand for Medical Workers in Kazakhstan: The Functional Principal Component Analysis Approach
by Berik Koichubekov, Bauyrzhan Omarkulov, Nazgul Omarbekova, Khamida Abdikadirova, Azamat Kharin and Alisher Amirbek
Int. J. Environ. Res. Public Health 2025, 22(7), 1052; https://doi.org/10.3390/ijerph22071052 - 30 Jun 2025
Viewed by 172
Abstract
The distribution of the health workforce affects the availability of health service delivery to the public. In practice, the demographic and geographic maldistribution of the health workforce is a long-standing national crisis. In this study, we present an approach based on Functional Principal [...] Read more.
The distribution of the health workforce affects the availability of health service delivery to the public. In practice, the demographic and geographic maldistribution of the health workforce is a long-standing national crisis. In this study, we present an approach based on Functional Principal Component Analysis (FPCA) of data to identify patterns in the availability of health workers across different regions of Kazakhstan in order to forecast their needs up to 2033. FPCA was applied to the data to reduce dimensionality and capture common patterns across regions. To evaluate the forecasting performance of the model, we employed rolling origin cross-validation with an expanding window. The resulting scores were forecasted one year ahead using Autoregressive Integrated Moving Average (ARIMA) and Long Short-Term Memory (LSTM) methods. LSTM showed higher accuracy compared to ARIMA. The use of the FPCA method allowed us to identify national and regional trends in the dynamics of the number of doctors. We identified regions with different growth rates, highlighting where the most and least intensive growth is taking place. Based on the FPSA, we have predicted the need for doctors in each region in the period up to 2033. Our results show that the FPCA can serve as a significant tool for analyzing the situation relating to human resources in healthcare and be used for an approximate assessment of future needs for medical personnel. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
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12 pages, 247 KiB  
Article
Equitable Healthcare Access for Type 2 Diabetes Patients Under a Low-Income Group Health Care Scheme: A Sustainable Development Goal Perspective
by Sin Wei Tey, Kingston Rajiah, Mari Kannan Maharajan, Norasila Binti Zakaria and Nor Haslinda Binti Ishak
Int. J. Environ. Res. Public Health 2025, 22(6), 817; https://doi.org/10.3390/ijerph22060817 - 22 May 2025
Viewed by 456
Abstract
Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key [...] Read more.
Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
17 pages, 274 KiB  
Article
Improving Access to Radiotherapy: Exploring Structural Quality Indicators for Radiotherapy in Gauteng Province, South Africa
by Portia N. Ramashia, Pauline B. Nkosi and Thokozani P. Mbonane
Int. J. Environ. Res. Public Health 2025, 22(4), 585; https://doi.org/10.3390/ijerph22040585 - 8 Apr 2025
Cited by 1 | Viewed by 541
Abstract
Background: Radiotherapy is a critical component of effective cancer treatment, yet access remains limited in many low- and middle-income countries, including South Africa. This study explores structural quality indicators influencing radiotherapy access in Gauteng province, a region with a dual public–private healthcare system. [...] Read more.
Background: Radiotherapy is a critical component of effective cancer treatment, yet access remains limited in many low- and middle-income countries, including South Africa. This study explores structural quality indicators influencing radiotherapy access in Gauteng province, a region with a dual public–private healthcare system. Methods: A concurrent triangulation mixed-methods approach using a descriptive cross-sectional study was employed; for the quantitative phase, data from public and private radiotherapy facilities was analysed, and for the qualitative phase, insights were obtained from interviews with the heads of departments and members of three multidisciplinary professions in radiation oncology, namely radiation oncologists, radiation therapists, and medical physicists. Results: Findings reveal stark disparities in radiotherapy access. Gauteng province has only two major public radiotherapy facilities serving a large population, while multiple private facilities exist. The data indicate substantial differences in resource distribution, equipment accessibility, and personnel levels between public and private institutions. Bureaucratic inefficiencies, personnel shortages, and operational limitations in the public sector have surfaced as significant barriers to prompt equitable access to radiotherapy. This research shows the urgent need for focused strategies to address these systemic issues in order to improve access to radiation treatment in Gauteng province. The study’s findings will inform the development of a comprehensive framework to enhance radiotherapy access and contribute to more equitable cancer care delivery in South Africa. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
13 pages, 262 KiB  
Article
Social Determinants and Health Equity Activities: Are They Connected with the Adaptation of AI and Telehealth Services in the U.S. Hospitals?
by Pearl A. Pinera, Pearl C. Kim, Fye A. Pinera and Jay J. Shen
Int. J. Environ. Res. Public Health 2025, 22(2), 294; https://doi.org/10.3390/ijerph22020294 - 17 Feb 2025
Viewed by 1123
Abstract
In recent decades, technological shifts within the healthcare sector have significantly transformed healthcare management and utilization, introducing unprecedented possibilities that elevate quality of life. Organizational factors are recognized as key drivers in technology adoption, but involvement of hospitals in community-oriented activities and promotion [...] Read more.
In recent decades, technological shifts within the healthcare sector have significantly transformed healthcare management and utilization, introducing unprecedented possibilities that elevate quality of life. Organizational factors are recognized as key drivers in technology adoption, but involvement of hospitals in community-oriented activities and promotion of health equity are underexplored. This study investigated the impact of community social determinant activities and health equity activities on the adoption of AI and telehealth services within U.S. hospitals. The data were collected from the 2021 American Hospital Association (AHA) annual survey and were analyzed using multiple logistic and linear regression models to examine activities related to addressing population health, particularly social determinants and health equity, and their impacts on the adoption of AI and telehealth among U.S. hospitals. The results indicate a significant positive association between the community social determinant indicator and health equity indicator in adopting AI and telehealth services. Organizational factors were also major drivers of AI and telehealth adoption. The active incorporation of hospital strategies that address social determinants and promote health equity leads to the integration of advanced technologies and improves hospital conditions, enabling more adaptability to the changing healthcare landscape, which enhances healthcare services and accessibility. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
22 pages, 353 KiB  
Article
Exploring Managers’ Insights on Integrating Mental Health into Tuberculosis and HIV Care in the Free State Province, South Africa
by Christo Heunis and Gladys Kigozi-Male
Int. J. Environ. Res. Public Health 2024, 21(11), 1528; https://doi.org/10.3390/ijerph21111528 - 18 Nov 2024
Viewed by 1516
Abstract
The integration of mental health (MH) services into tuberculosis (TB) and HIV care remains a significant challenge in South Africa’s Free State province. This study seeks to understand the perspectives of public health programme managers on the barriers to such integration and to [...] Read more.
The integration of mental health (MH) services into tuberculosis (TB) and HIV care remains a significant challenge in South Africa’s Free State province. This study seeks to understand the perspectives of public health programme managers on the barriers to such integration and to identify potential strategies to overcome these challenges. Data were collected between February and October 2021 using qualitative methods including four individual semi-structured interviews and two focus group discussions with a total of 15 managers responsible for the MH, primary healthcare, TB, and HIV programmes. Thematic data analysis was guided by an adapted version of the World Health Organization’s “building blocks” framework encompassing “service delivery”, “workforce”, “health information”, “essential medicines”, “financing”, and “leadership/governance”. Additionally, the analysis underscored the crucial role of “people”, acknowledging their significant contributions as both caregivers and recipients of care. Managers highlighted significant concerns regarding the insufficient integration of MH services, identifying structural barriers such as inadequate MH management structures and staff training, as well as social barriers, notably stigma and a lack of family treatment adherence support. Conversely, they recognised strong management structures, integrated screening, and social interventions, including family involvement, as key facilitators of successful MH integration. The findings emphasise the need for a whole-system approach that addresses all building blocks while prioritising the role of “people” in overcoming challenges with integrating MH services into TB and HIV care. Full article
(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)
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