Water Ambulance Service Provision to Improve Healthcare Access for Community in Nusa Penida Island, Bali: A Qualitative Feasibility Study
DOI:
https://doi.org/10.53638/phpma.2022.v10.i2.p07Keywords:
healthcare access, water ambulance, islands region, rural health , IndonesiaAbstract
Background and purpose: An important component of healthcare access is transportation. Lack of transportation has been cited as an important barrier to healthcare access in remote islands region. Here we conduct a feasibility study on the implementation of water ambulance service to improve healthcare access in the region of Nusa Penida and its surrounding islands in Bali Province, Indonesia.
Methods: We employed a qualitative approach with interviews and focused group discussions with stakeholders. Data collection was conducted to assess the feasibility of operating water ambulance services, based on a framework that included technical, market, organizational, and financial feasibilities. Inductive coding was conducted and data was analyzed to evaluate the feasibility based on local capacity against pre-determined framework of assessment based in literature.
Results: Qualitative interviews revealed perceived urgency and need for water ambulance service among stakeholders. They also perceive the need of water ambulance service was not mutually exclusive to other alternatives, such as expanding healthcare capacity on the islands. There was also readiness and adequate capacity from stakeholders which include a dedicated health emergency services under the health office that coordinate ambulance service in the region, readiness to create dedicated medical team and boat crew to operate water ambulance services, and readiness to cover the cost of initial procurement followed by operational costs which may include public-private partnerships.
Conclusion: There was a strong perceived need for water ambulance service in Nusa Penida Islands. At the same time, local stakeholders revealed adequate basic capacity to feasibly operate water ambulance services according to benchmarks identified in literature review.
References
Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health [Internet]. 2015;129(6):611–20. Available from: http://dx.doi.org/10.1016/j.puhe.2015.04.001
Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: A systematic literature review. BMC Health Serv Res. 2019;19(1):1–17.
Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016. Lancet. 2018;391(10136):2236–71.
Klungkung District Health Office. Klungkung Health Profile 2019 [Internet]. Amlapura; 2019. Available from: https://www.diskes.baliprov.go.id/download/profil-kesehatan-klungkung-2019/
Central Statistics Body. Annual Report of International Tourist in Bali 2019 [Internet]. Jakarta; 2020. Available from: https://bali.bps.go.id/publication/2020/07/24/e40b575f055874fc2eb05eee/statistik-wisatawan-mancanegara-ke-bali-2019.html
Dos Anjos Luis A, Cabral P. Geographic accessibility to primary healthcare centers in Mozambique. Int J Equity Health [Internet]. 2016;15(1):1–13. Available from: http://dx.doi.org/10.1186/s12939-016-0455-0
Slabbert JA, Smith WP. Patient transport from rural to tertiary healthcare centres in the Western Cape: Is there room for improvement? African J Emerg Med [Internet]. 2011;1(1):11–6. Available from: http://dx.doi.org/10.1016/j.afjem.2011.04.001
Mgawadere F, Unkels R, Kazembe A, van den Broek N. Factors associated with maternal mortality in Malawi: Application of the three delays model. BMC Pregnancy Childbirth. 2017;17(1):1–9.
Wilson A, Hillman S, Rosato M, Skelton J, Costello A, Hussein J, et al. A systematic review and thematic synthesis of qualitative studies on maternal emergency transport in low- and middle-income countries. Int J Gynecol Obstet [Internet]. 2013;122(3):192–201. Available from: http://dx.doi.org/10.1016/j.ijgo.2013.03.030
Berry GR, Feasibility Analysis for the New Venture Nonprofit Enterprise, New England Journal of Entrepreneurship, 2017; Fall/Winter:52-69.
Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease. J Community Health. 2013;38(5):976–93.
Weiss DJ, Nelson A, Vargas-Ruiz CA, Gligorić K, Bavadekar S, Gabrilovich E, et al. Global maps of travel time to healthcare facilities. Nat Med [Internet]. 2020;26(12):1835–8. Available from: http://dx.doi.org/10.1038/s41591-020-1059-1
Babiarz KS, Mahadevan S V., Divi N, Miller G. Ambulance service associated with reduced probabilities of neonatal and infant mortality in two Indian states. Health Aff. 2016;35(10):1774–82.
Chanta S, Mayorga ME, McLay LA. Improving emergency service in rural areas: a bi-objective covering location model for EMS systems. Ann Oper Res. 2014;221(1):133–59.
Croker JE, Campbell JL. Satisfaction with access to healthcare: Qualitative study of rural patients and practitioners. Prim Heal Care Res Dev. 2009;10(4):309–19.
Pusaka A, Dewanto YA, Octaviany F. Study of ambulance ship design for island services in Indonesia. J Phys Conf Ser. 2020;1469(1).
Suhaeri LL, Hasanbasri M. Manajemen Pelayanan Rujukan dengan Speed Boat di Kabupaten Pelalawan Provinsi Riau [The management of referral services with speed boat in Pelalawan District, Riau Province] [Internet]. Gadjah Mada University; 2010. Available from: http://etd.repository.ugm.ac.id/home/detail_pencarian/45446
Rut A, Klosiewicz T, Mandecki M, Nowicki M, Maciejewski A. The Functioning of the Maritime Medical Rescue Team: the Example of Slupsk Emergency Medical Service Water Ambulance. Disaster Emerg Med J. 2017;2(4):160–3.
Kalbuadi F, Kurniawati HA. Desain Amphibious High Speed Ambulance Craft (HSAC) sebagai Penunjang Fasilitas Kesehatan di Kepulauan Raja Ampat [Amphibious High Speed Ambulance Craft (HSAC) Design as a supporting health facility at Raja Ampat Islands]. J Tek ITS. 2020;9(2).
Maritime & Coastguard Agency. The Rescue Boat Code [Internet]. 2013. Available from: https://www.gov.uk/government/publications/the-rescue-boat-code
NHS. Specifications of medical equipments for ERS Ambulances under National Health Mission [Internet]. 2016 [cited 2021 May 4]. Available from: https://nhm.gov.in/images/pdf/programmes/ERS/Specification_of_Equipments_for_ERS_Ambulance.pdf
de la Torre GPT, Jerchel K, Yoshida K. Cost-Benefit Analysis of a Sea Ambulance Project in The Municipality of Alabat in Quezon Province, Philippines. University of Tokyo; 2015.
Juban NR, Reyes JL, Ongkeko AM. Inter-Island Health Service Boat Project, Philippines [Internet]. Geneva; Available from: https://socialinnovationinhealth.org/case-studies/inter-island-health-service-boat-project/
Forrey GW, D’Cruz JJ, Gvetadze N, Goswami R. Delivering Primary Health Care and Education to the Brahmaputra River Islands A case study of the Akha: Boat of Hope. New Delhi; 2008.
Nukavarapu N, Durbha S. Interdependent healthcare critical infrastructure analysis in a spatiotemporal environment: A case study. ISPRS Int J Geo-Information. 2020;9(6):1–s30.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Putu Aryani, Ngakan Putu Anom Harjana, Pande Putu Januraga, Desak Ketut Dewi Satiawati Kurnianingsih, Gede Benny Setia Wirawan, Ni Made Adi Swapatni, I Komang Gede Sentanu Wibawa
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
**Creative Commons Attribution 4.0 International License (CC BY 4.0)**
*Welcome to the world of open collaboration and shared creativity! The Creative Commons Attribution 4.0 International License (CC BY 4.0) empowers creators to share their work with the world while maintaining certain rights.*
**Key Points:**
1. **Freedom to Share:** CC BY 4.0 allows creators to share their work globally, granting others the freedom to use, remix, and build upon it.
2. **Attribution Requirement:** Users can use the work for any purpose, even commercially, as long as they provide appropriate credit to the original creator.
3. **Flexibility:** Applicable to various content types—text, images, music, videos—the license fosters a diverse range of creations.
**Common Use Cases:**
- **Education:** Widely used for educational materials, promoting open learning environments.
- **Research:** Applied to scholarly articles, accelerating the dissemination of knowledge.
**How to Use:**
1. **Share:** Share your work with the world, marking it with the CC BY 4.0 license.
2. **Attribution:** Users, when utilizing the work, must provide proper attribution to honor the original creator.
**Conclusion:**
CC BY 4.0 contributes to a more open and collaborative digital landscape. Join the movement of shared knowledge and creativity!
*For full license details, visit [Creative Commons](https://creativecommons.org/licenses/by/4.0/).*
