Anglia Ruskin University
Access to health care is the practical usage of personal health services to achieve the best health outcomes. Access to healthcare helps the person get better care, helps improve health outcomes, prevents disease progression, and reduces treatment costs (Bhatt and Bathija, 2018). There are some barriers to which people cannot access healthcare facilities; health inequality is one of them. Health inequalities can be defined as the variance in people's health status. It can be stated as the alteration in the care people receive and their chances (Bambre, 2022). Health inequalities can include changes in health status, access to care, quality of care, behavioural risks of health and broader determinants of health. Here in this project, we focus on access to care for the people living in the district of Uttar Pradesh in India. Despite several policies and development in the provision of healthcare access, India's health system still struggles with the challenges of addressing inequalities. It has been reported that the district of Uttar Pradesh (UP) is one of the poorest states of India in the health sector (Kumari & Raman, 2022). Over 200 million people reside in UP, which makes UP the largest state in India in terms of population. However, it ranked inferior than other states in Health (Singh, 2019). Healthcare services in UP are majorly delivered through a privately funded system. The report from National Sample Survey Organizations in 2014 states that about 80% of all then outpatients and nearly 60% of hospital episodes occur in the private sector, indicating the lack of involvement of government organizations in healthcare services (Kumari and Raman, 2022).
In the proposal, the Health Needs Assessment (HNA) method will be implicated to improve Health and reduce inequalities. HNA is a systematic method for studying the health issues fronting a population, leading to arranged urgencies and resource allocations that will advance Public health and decrease inequalities (Harland et al., 2022). In the proposal, with the help of HNA, a specific population of UP will be targeted, and the factors leading to health inequalities will be addressed. Last, the proposal will implicate effective interventions to engage the specific population and enable them to access healthcare facilities.
Health is stated as a positive concept that emphasizes social and personal resources and physical capabilities. Health equality is an essential part of the medical sector, but sadly this is not achieved. Discrimination in the healthcare sector is a traditional issue which people in UP are still facing on a wider scale (McCartney et al.., 2019). Health inequalities go in contradiction with the principles of social justice; these are preventable as well as unjust and unfair. It any cause a negative impact on the results of health policies and can lead to poor quality of Health, so there is a need to address issues associated with it. In India, there are numerous frameworks, policies and programs in place both at the international level and at the national level to address health inequalities. There is a need to overview these policies and take feedback on how much they are able to act to reduce health inequalities; However, due to the absence of management of these policies and inability to implicate them in rural areas, the steps are needed to be taken to deal with these concerns (Stormacq et al., 2019). The rationale of the current proposal is to provide an overview of the factors that are linked with the health inequalities in Uttar Pradesh and to identify the barriers to equal access to healthcare facilities. HNA is one of the methods being used across sectors to improve Mental Health and reduce health inequalities (Handyside et al., 2021). In the current proposal, the health needs of the population are focussed on by using HNA, and multiple interventions are put forward for the development and delivery of improved programmes and services. The implementation will be helpful in discovering the areas of weakness and strength in the proposal and strengthening community involvement in decision-making (Cho et al., 2018). HNA is beneficial in improving team and partnership working and developing the professional skills of the team members. However, some challenges are also associated with HNA, like difficulty in accessing the relevant data and target population and in emerging a shared language between sectors (Handyside et al., 2021).
The epidemiological approach to Health needs assessment is the traditional approach that has been used to describe the need relative to a specific health problem by considering the precise health problems using estimations of the incidence, prevalence, and other surrogates of health impact derived from studies carried out locally or elsewhere (Stormacq et al., 2019) If we describe the epidemiology, it is the study of the distribution and determinants of Health-related stress or events in a specific population and the application of this study to control the health problems. In the current proposal, the epidemiological approach is used to investigate the factors that are responsible for the inequality in access to healthcare services in the specific population group of UP (Bhatt and Bathija, 2018).
Aim: The proposal aims to identify the barriers to access to healthcare and to implement strategies that can help in reducing health inequality in the state of Uttar Pradesh.
Goal: The primary goal of the proposal is to increase access to healthcare care services to attain the highest possible level of Health and well-being for all people in Uttar Pradesh and of all ages.
Access to healthcare facilities is a significant factor in maintaining the health status and socioeconomic value of the state. Previous studies conducted about health inequality in UP are based on the majorly on the life expectancy of the population in UP and how health inequalities have affected the living conditions (Bhatt & Bathija, 2018).
The current proposal aims to provide effective knowledge to the reader about the factors responsible for health inequalities and what interventions need to be implicated in the healthcare system to prevent inequalities in access to clinical nursing healthcare services. The study will focus on the social determinants of Health which are rarely highlighted by any study because of the fear of ethical conflicts. There is a need to focus on the gap between the government policies' development and implementation, through this proposal we understand the issues and barriers that the people in UP are facing to get access to medical services available by the government (Kumari and Raman, 2022)
The project team from the current proposal include the project manager, who leads the other team member and organizes the overall proposal. The project manager organizes the team and distributes the work according to their roles. The project team leaders are appointed by the project manager, who has a role in directing the team members of their committees. Each team have ten team members who are assigned duties within the sphere of the project.
There is a rising interest in stakeholder engagement as a possibly promising approach to promoting research impact. To reduce the gap between research production and research use, the project includes the stakeholders. In the current project, stakeholders are regional chairpersons, committee members, resource managers and suppliers of resources; the minor contribution is from the team members. The active involvement of the stakeholders in the research will more organizationally factors, values and practices (Boaz et al., 2018).
The primary data will be collected by conducting a random interviews with people from different communities living in different regions of UP. The team members will conduct the field survey and collect the data by conducting an in-person interview using the pre-scripted questionnaire. One hundred participants will be included in the study, both male and female, of different age groups. Participants below the age group of 15 and above 65 will not be included in the study. The interview will be recorded both in audio and video format, which will be later analyzed and interpreted. Before conducting the interview, the study will take the informed consent of the participant, the purpose of the study will be clarified to the group participant, and those who will be voluntarily involved in the study will be selected for the participant. While conducting an interview, the participant will not be forced; he/ she will have the free will to quit the interview or skip the question if they find it difficult to answer (McCartney et al., 2019).
for the comparison of the data collected with the pre-existing data, the study will use secondary resources like PubMed and CINAHL. The data about the population of UP and their specific problems will be collected from relevant resources like published journals, books, and research articles which are related to our work. For the selection of the journals and articles, the project will apply the language and duration barrier; studies published in English will be selected no other language will be preferred. Articles published after the year 2018 will be included so that the study will include the latest available data. For the collection of secondary data, the key works, including health inequality, barriers to health equality and challenges for health equality, will be used (Singh, 2019).
The primarily collected data will be analyzed by using SPSS statistical tool. The data collected through audio and video recording will be reviewed, and only relevant data will be processed. For the secondary data analysis, the selected studies will be grouped according to their link with the aim of the proposal, and those that will not relate to the current study will be neglected. For the comparison of the raw data collected by the fieldwork, these selected studies will be used.
To find out the distribution of healthcare workers: It has been reported that UP has a relatively short number of front-line workers. The public health system has suffered a shortfall among all cadres of the workforce, about 36% of the shortfall among doctors, 80% of specialists, 50% of nurses and overall 70% of lab technicians. People living in the rural areas of UP are majorly affected by the uneven distribution of healthcare services. Healthcare access in rural areas is limited because the majority of the healthcare workers are appointed in urban healthcare settings, due to which people living in rural areas have to visit private healthcare settings, resulting in higher costs. The proposal will work to find what services rural people are able to obtain and what barriers they face in the private sector (Singh, 2019).
Promoting health literacy: In the current study, the major priority is to educate the people about Health and the needed strategies to promote Health. Health literacy can be defined as the process of access and understanding of using the information in ways which can help to endorse and maintain good Health. In most of the states of India, including UP, it has been reported that people who have high literacy levels are able to seek more healthcare services in comparison to those who are illiterate or have a poor literacy status. To promote health literacy, the current proposal will use the interventions like arranging educational campaigns in which people are educated through video and audio presentations (Singh, 2019).
There is a need to improve health literacy to reduce the rate of health inequality majority of the people a residing in rural areas where the development of healthcare services is not up to mark, so there is a need to approach government policies to have an active role in improving their services and engage successfully with community action for health (McCartney et al., 2019). It has been observed that people with higher levels of health literacy are able to adopt healthy behaviour and receive Universal health coverage. Poverty is also reported as one of the major factors which act as a barrier to increasing health inequality. To promote the level of health literacy among people in UP, we need to consider poverty and act on it (McCartney et al., 2019).
From the proposal, it can be expected that the overall health of the people in UP can be enhanced by implicating the interventions that can help to promote health literacy. We expect that the interventions can make people aware of their health needs and increase access to healthcare facilities. During the study, the social determinants of healthy living conditions and poverty are also reported as a factor that may lead to increased health inequalities; the proposal worked to approach the government policies to reduce the burden of poverty and unemployment in the rural areas of UP. This project will help the future researcher to gain collective information about the factors responsible for health inequalities and the interventions that can reduce health inequalities and promote access to healthcare (Singh, 2019).
Health inequality is a significant challenge which the people in UP are facing. It also leads to other problems like lack of access to healthcare services. It has been reported that due to poor health literacy majority of the people in UP are unaware of the early sign and symptoms of disease and unable to seek the available treatment. The socioeconomic factors are responsible for increasing the health burden in UP people who have low economic status suffer more. The unavailability of healthcare workers in rural areas contributes to maternal and neonatal deaths. The current research proposal will help the people in UP to learn more about healthcare services and to get access to these facilities. The proposal will educate the people in UP about better living conditions.
The health status of the people in UP is below average. Several studies show that the UP shows a low disparity in terms of health status and in health infrastructure. While designing the current project, I focused on the measures to the extent of the inequality in the health status and health care services in the state of UP. I realized that the health status is not only affected by the poor health care services but also because of less involvement of principal government commitment and policies.
During the data collection and gathering of information for the project, I face several challenges, which makes me aware of the reality. The major challenge that I faced was the lack of interaction with the people. UP is a big state and collecting information from all over the state is difficult because of having limited team members. So, we decided to collect data from several regions which are easily approachable (Roh et al., 2019). My team members faced language barriers while conducting the individual interview of the people from local communities. Due to a lack of knowledge about the different cultural backgrounds of the community, team members are not able to provide culturally safe practices and do not understand the value of the data. Collecting data by using a questionnaire is not possible as the majority of the people in UP are not able to read or write. The majority of the people are unavailable during day time as they have to go to work, so we face challenges to collect the participants; also, people are not voluntary to answer the questions; they do not want to waste their time by giving interviews (Adbar et al., 2021).
The insufficiently trained staff acts as a barrier to data collection, most of the team members are not clear about the aim and objective of the project and lack an understanding of the context. I faced difficulty in data collection, as I did not receive any training in this area. While asking questions to the participants, I feel less confident or ask them in a different way. I was ashamed to ask questions about sexual orientation or intersex variation; I feared may be the person might get offended or experience discomfort (McCartney et al., 2019).
Data collection lacks the quality assurance process; the project lacks a service person who can cross-verify the collected data. Due to the resources and the time duration, the sophistication of record keeping system can vary and the data quality could be compromised. During the data collection, I realized that people from different communities have different perspectives on health and healthcare resources. In rural areas, we are not allowed to make direct contact with a female member of the family because of their custom and rituals. The lack of resources like spare camera batteries and limited audio recorders brings challenges during the interview.
To cope with the ineffective interaction with the people, proper training should be provided to the team members like how to begin the conversation, how to involve the person in the interview and how to convince them if they refuse to answer the questions. The project is not able to include a large number of participants because of a shortage of staff and team members; there is a need to add more skilled people to the team who are multitasking and know how to interact with the people of local communities. To overcome the language barrier, we can include a team member from a regional background who is familiar with the local language. Questions which may offend the person and may cause harm to the cultural beliefs should not be asked. I suggest that team should include more female members who can directly interact with the women in rural areas and collect in-depth information about the discrimination and health inequality they face in healthcare (Bambra, 2022).
To increase the number of participants for the data collection, we have to choose the time at which most of the people are at home, like the evening time. Informed consent should be taken from the participants, and the information related to the study will be informed to the participant. To increase the effectiveness of the data collected, it will be cross-checked by two team members all the repetitive and irrelevant data will be deleted. There is a need to improve health literacy to reduce the rate of health inequality majority of the people a resigning in the ruler areas where the development of healthcare services is not up to mark, so there is a need to approach government policies to play an active role in improving their services and English successfully with community action for Health. To prevent challenges during the interview we will approach the stakeholders to increase the fund of the project so that the availability of the resource will not be a barrier (Singh, 2019).
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Although my team and I face many challenges in data collection and interpretation, I am satisfied with my work and clear about the future strategies that I will implicate in the upcoming projects. I am glad to be a part of this welfare project, learn about what people are facing in the outside world, and get some motivation to improve my life quality.
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