PMID- 33045653
OWN - NLM
STAT- MEDLINE
DCOM- 20210427
LR  - 20210427
IS  - 1873-5347 (Electronic)
IS  - 0277-9536 (Linking)
VI  - 265
DP  - 2020 Nov
TI  - Accessibility to First-Mile health services: A time-cost model for rural Uganda.
PG  - 113410
LID - S0277-9536(20)30629-8 [pii]
LID - 10.1016/j.socscimed.2020.113410 [doi]
AB  - This study estimates the geographical disconnection in rural Low-Middle-Income 
      Countries (LMIC) between First-Mile suppliers of healthcare services and 
      end-users. This detachment is due to geographical barriers and to a shortage of 
      technical, financial, and human resources that enable peripheral health 
      facilities to perform effective and prompt diagnosis. End-users typically have 
      easier access to cell-phones than hospitals, so mHealth can help to overcome such 
      barriers, transforming inpatients/outpatients into home-patients, decongesting 
      hospitals, especially during epidemics. This generates savings for patients and 
      the healthcare system. The advantages of mHealth are well known, but there is a 
      literature gap in the description of its economic returns. This study applies a 
      geographical model to a typical LMIC, Uganda, quantifying the time-cost to reach 
      an equipped medical center. Time-cost measures the disconnection between 
      First-Mile hubs and end-users, the potential demand of mHealth by remote 
      end-users, and the consequent savings. The results highlight an average time-cost 
      of 75 min, well above the recommended thresholds, and estimate that mHealth leads 
      to significant savings (1.5 monthly salaries and 21% of public health budget). 
      Community health workers and private actors may re-engineer healthcare resources 
      through Public-Private Partnerships (PPP), remunerated with results-based 
      financing (RBF). These findings can contribute to improving healthcare resource 
      allocation in LMIC.
CI  - Copyright (c) 2020 Elsevier Ltd. All rights reserved.
FAU - Visconti, Roberto Moro
AU  - Visconti RM
AD  - Department of Business Management, Catholic University of Sacred Heart, Via 
      Ludovico Necchi, 7, 20123, Milan, Italy. Electronic address: 
      roberto.moro@unicatt.it.
FAU - Larocca, Alberto
AU  - Larocca A
AD  - Cosmo Ltd., A183/20, 11th Close South Odorkor Estate Greater Accra, Ghana. 
      Electronic address: alb.larocca@gmail.com.
FAU - Marconi, Michele
AU  - Marconi M
AD  - Universita Politecnica delle Marche, Dipartimento di Scienze della, Vita e 
      dell'Ambiente, Via Brecce Bianche, 60126, Ancona, Italy. Electronic address: 
      mik.marconi@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20201005
PL  - England
TA  - Soc Sci Med
JT  - Social science & medicine (1982)
JID - 8303205
SB  - IM
MH  - Delivery of Health Care
MH  - Health Services
MH  - Health Services Accessibility
MH  - Humans
MH  - *Rural Health Services
MH  - Rural Population
MH  - *Telemedicine
MH  - Uganda
OTO - NOTNLM
OT  - Barriers to care
OT  - Geographic information systems
OT  - Healthcare cost-effectiveness
OT  - Home-patient
OT  - Remote diagnosis
OT  - Results-based financing
EDAT- 2020/10/13 06:00
MHDA- 2021/04/28 06:00
CRDT- 2020/10/12 20:15
PHST- 2020/07/10 00:00 [revised]
PHST- 2020/09/30 00:00 [accepted]
PHST- 2020/10/13 06:00 [pubmed]
PHST- 2021/04/28 06:00 [medline]
PHST- 2020/10/12 20:15 [entrez]
AID - S0277-9536(20)30629-8 [pii]
AID - 10.1016/j.socscimed.2020.113410 [doi]
PST - ppublish
SO  - Soc Sci Med. 2020 Nov;265:113410. doi: 10.1016/j.socscimed.2020.113410. Epub 2020 
      Oct 5.