Recent closures of rural obstetric units and entire hospitals have exacerbated concerns about access to care for more than twenty-eight million women of reproductive age living in rural America. Yet the extent of recent obstetric unit closures has not yet been measured. Using national data, we found that 9 percent of rural counties experienced the loss of all hospital obstetric services in the period 2004-14. In addition, another 45 percent of rural US counties had no hospital obstetric services at all during the study period. That left more than half of all rural US counties without hospital obstetric services. Counties with fewer obstetricians and family physicians per women of reproductive age and per capita, respectively; a higher percentage of non-Hispanic black women of reproductive age; and lower median household incomes and those in states with more restrictive Medicaid income eligibility thresholds for pregnant women had higher odds of lacking hospital obstetric services. The same types of counties were also more likely to experience the loss of obstetric services, which highlights the challenge of providing adequate geographic access to obstetric care in vulnerable and underserved rural communities.
Background Despite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC. Methods We conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use. Results The intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners. Conclusions Self-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW.
As Industrial Product-Service Systems (IPS2) are specified by integratedly considered product and service shares, they represent a new solution-oriented approach for delivering value in use to the customer during the whole life cycle of a product. The article to be launched describes the general approach of Industrial Product-Service Systems including motivation and definitions. The incorporated paradigm shift from leadership in technology to leadership in use enables innovative business models. It is shown how a flexible solution space arises from these business models. The broad overview of the scientific issues in Industrial Product-Service Systems is complemented by exemplary research results regarding the delivery phase, like modular organization and operational resource planning.
Purpose - Innovation in services is thought to be multi-dimensional in nature, and in this context the purpose of this paper is to present and operationalise the concept of "elevated service offerings" (ESO) in collaborating service organisations. ESO stands for new or enhanced service offerings which can only be eventuated as a result of partnering, and which could not be delivered on individual organisational merit. ESO helps us expand our understanding of service innovation to include a service network or service system's dimension. Design/methodology/approach - A structural equation model is specified and estimated based on constructs and relationships grounded in the literature, as well as self-developed constructs, using empirical data from 449 respondents in an Australian telecommunications service provider (SP) and its partnering organisations. Findings - Results show that ESO is a multi-dimensional construct which was operationalised and validated through an extensive literature review, exploratory factor analysis, confirmatory factor analysis, and structural equation modelling using a holdout sample. Research limitations/implications - Qualitative and empirical data analysis was undertaken with data collected from a single large telecommunications SP organisation, and its partnering organisations. Future research may seek to collect data from the entire telecommunications industry sector and their partnering organisations, across other service sectors, or even any other organisation where collaboration is pivotal to their success. Practical implications - Service organisations today need to understand that innovation in services is not just about process or product innovation, or even performance and productivity improvements, but in fact includes organisational forms of innovation. Indeed, the interactions and complementarities between the three different aspects of ESO strategic, productivity, and performance - highlight the increasing complex and multi-dimensional character of innovation and the ongoing iterative process. Originality/value - This research provides empirical evidence for the existence of a multi-dimensional innovation in services construct known as elevated service offerings in a collaborative service network, along with an adapted definition of service and a service innovation model.
This paper contributes to the discussion on integrating societal considerations, stakeholders' perceptions and laymen knowledge into ecosystem services (ES) assessments. The paper illustrates how social mapping of perceived ES supply (or alternatively demand) can contribute to integrated ES assessment. Based on sketched locations of the, according to 38 respondents, most important ES at the local scale, we describe the perceived ES distribution with social landscape metrics (abundance, diversity, richness, risk, rarity) based on traditional landscape ecology indicators. We illustrate how social landscape metrics can inform ES management and planning and describe how synergies between ES as stated by the respondents differ from calculated synergies (the latter based on correlation coefficients between perceived ES abundance). We present indicators pointing to locations where (multiple) ES synergies are perceived by stakeholders (stated synergy index), and to conflicting ES and ES perceived to be at risk (risk index). Overlapping social ES hotspots based on the social landscape metrics with ES hotspots based on more traditional biophysical modelling (biophysical hotspots) and ecological inventories (ecological hotspots) results in social–ecological or social–biophysical hotspots, coldspots and warmspots relevant for nature and landscape planning, management and governance. Based on an analysis of the overlaps between social, biophysical and ecological hotspots on the one hand, and the contribution of ecological quality, land zoning categories and conservation statuses on the other hand, we discuss the added value of integrating social ES mapping in integrated ES assessment, above ES assessments based on biophysical or ecological attributes. Given the limited overlap between social hotspots and ecological or biophysical hotspots, we conclude that integrating stakeholders' mapping of perceived ES supply (or demand) into ES assessments is necessary to reflect the societal aspects of ES in ES assessments. However, with a limited sample of respondents, there is a risk of collectivisation of respondents' viewpoints as a common, societal stance. Moreover, the social landscape metrics are not suitable for describing the distribution of ES with low perceived abundance. Finally, we explain how social ES assessment can result in mainstreaming ES in planning, policy and practice.
Service triads, in which a buyer contracts with a supplier to deliver services directly to the buyer's customer, represent an emerging business model. This special issue is dedicated to this theme. To set the context, in this lead article, we first define service triads, both as a phenomenon and a research topic. We then provide a review of different strands of existing research and various theoretical frameworks that can inform our study of service triads. This culminates in an outline of a research agenda that can guide future study. As such, this paper not only introduces the articles in the special issue, but is also intended as a point of reference and motivation for further work on service triads, and on triads in general.
Background: Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods: Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. Results: The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. Conclusions: The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.