Municipality-level differences in disability retirement in Finland: The contribution of local social characteristics.

AIMS: Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement. METHODS: Individual-level register data were supplemented with 10 municipality-level characteristics from various databases. A 20% sample of the Finnish population (N=626,391) was followed for transition to disability retirement from 2016 to 2019 using multilevel Weibull models. RESULTS: Of the total variation in the risk of disability retirement, 4.3% was attributed to the municipal-level and decreased to 1.8% when individual-level characteristics (gender, age, education level and entitlement to special reimbursement for medical expenses, reflecting morbidity) were controlled for. Further adjustment for municipality-level characteristics fully erased the differences between municipalities. The proportion of municipality-level variation was larger for disability retirement due to somatic illnesses than mental disorders. Of the municipality-level characteristics, socioeconomic structure, unemployment rate, poverty, net migration between municipalities, dependency ratio, the amount of tax revenue per capita and morbidity were associated with the risk of disability retirement. CONCLUSIONS: The municipality-level variation in the risk of disability retirement is largely explained by the individual characteristics of the inhabitants. However, various characteristics of the municipalities show associations with the risk of disability retirement. Recognizing such factors is essential for shaping policies that mitigate disability retirement risk.

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study.

BACKGROUND: Morbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents' HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05. RESULTS: 63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions "Anxiety/Depression" (94.4%) and "Pain/Discomfort" (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer. CONCLUSION: Our study revealed elevated proportions of reported problems in the "Anxiety/Depression" and "Pain/Discomfort" dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters.

BACKGROUND: Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS: The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS: The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS: The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults.

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.

OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Closing the equity deficit: Sustainability justice in municipal climate action planning in Waterloo region.

There is growing recognition that often well-intended climate action solutions perpetuate and exacerbate manifestations of colonialism and racism due to the lack of equity and justice considerations in designing and implementing these solutions. There is limited research exploring why the integration of these considerations are lacking in municipal climate action planning. This exploratory descriptive qualitative study explored how municipal actors perceive and understand equity and justice in municipal climate action planning as a step toward addressing this issue. Semistructured interviews were conducted with seven members of the core management group from ClimateAction Waterloo region, and a template analysis of the interview data resulted in six themes. Findings suggested that those involved in municipal climate action planning understand and perceive justice and equity considerations as important to their work, however, translating this understanding to practice is a challenge due to structural (governmental and societal) and capacity (limited time, funding, resources, and knowledge) barriers. By better understanding how key actors consider justice and equity, we identify shifting colonial mental models as a potential pathway for transformative change given the central role of these actors.

Synergizing remote sensing and ecological indicators (RSEIs) for evaluating ecological environmental quality (EEQ) in Asansol Municipal Corporation: an integrated approach.

Human activities have dramatically affected global ecology over the past few decades. Geospatial technologies provide quick, efficient, and quantitative evaluation of spatiotemporal changes in eco-environmental quality (EEQ). This study focuses on a novel approach called remote sensing-based ecological indicators (RSEIs), which has used Landsat imagery data to assess environmental conditions and their changing trends. Four ecological indicators, mainly heatness, dryness, wetness, and greenness, have been used to assess the EEQ in Asansol Municipal Corporation Region (AMCR). Assembling all the indicators to generate RSEI, the principal component analysis (PCA) approach was applied. Our findings show that wetness and greenness favorably impact the province's EEQ, whereas dryness and heat create a negative impact. The RSEI assessment revealed that 24.53 to 28.83% of the area was poor and very poor, whereas the areas with very good decreased from 18.80 to 4.01% from 2001 to 2021 due to urban expansion and industrialization. The relative importance analysis indicates that greenness has a positive relation with RSEI, and dryness and heatness have a negative relation with RSEI. Finally, the receiving operating characteristic (ROC) was used for validation (AUC-0.885) of the RSEI. This study offers valuable insights for ecological management decision-making, guiding planners, and policymakers.

Estimated number of deaths attributable to NO2, PM10, and PM2.5 pollution in the Municipality of Milan in 2019.

BACKGROUND: there is growing evidence that exposure to environmental pollutants affects health, including mortality, chronic diseases, and acute diseases. The World Health Organisation has recently revised downwards the safety thresholds for exposure to environmental pollutants. The City of Milan (CoM) has particularly high levels of pollution; this is due both to the presence of various emission sources and to climatic and orographic conditions. OBJECTIVES: to describe the health effects of exposure to pollutants, measured by deaths due to environmental exposure to NO2, PM10, and PM2.5 in 2019. DESIGN: observational study. Using a pollutant concentration estimation model, annual mean values of NO2, PM10, and PM2.5 were estimated for the CoM in 2019. The number of deaths attributable to each exposure was estimated using risk functions available in the literature; the values recommended by the new World Health Organisation guidelines were used as counterfactual exposure limits. SETTING AND PARTICIPANTS: the population assisted by the Agency for Health Protection of Milan and resident in the CoM on 01.01.2019, aged 30 years or older. The place of residence was georeferenced and the population was followed up until 31.12.2019. Deaths and their causes were obtained from the Causes of Death Registry. MAIN OUTCOME MEASURES: deaths attributable to exposure from non-accidental causes, cardiovascular diseases, respiratory diseases, and lung cancer were estimated. RESULTS: in 2019, the estimated annual average level of NO2 was 36.6 µg/m3, that of PM10 was 24.9 µg/m3, and that of PM2.5 was 22.4 µg/m3, with levels varying across the city area. Concerning exposure to NO2, in 2019 10% of deaths for natural causes were estimated to be attributable to annual mean levels of NO2 above 10 µg/m3. As regard PM2.5, 13% of deaths for natural causes and 18% of deaths from lung cancer were attributable to an annual mean level above 5 µg/m3. The impact of exposure to particulate matter on mortality does not seem to be the same in all the areas of the CoM. CONCLUSIONS: the health impact of exposure to airborne particulate matter in the CoM population is high. It is important that citizens, policy-makers, and stakeholders address this issue, because of its impact on both health and healthcare costs.

Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway.

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

[The characteristics of prevention of drug addiction and narcotism in municipal formation of city of Novorossiysk].

The drug addiction is one of most serious deviant behavior seriously harming both addict person and one's relationship. The drug using is considered as deviant because means using substances from non-legal turn-over or applied in non-medical purposes. Then follows degradation of health of person and one's positioning into physical and mental dependence on them. With time, personal dependence on drugs becomes stronger. The addicted person looses possibility to experience joy from natural stimuli and more difficulties in controlling drug using appear. Persons using drugs frequently commit crimes to have money to maintain one's dependence. Therefore, issues of prevention narcotism and struggle with drug addiction are fundamental ones for whole system of prevention in Novorossiysk. The article presents analysis of implemented activities and adopted measures of struggle with drug addiction in population of Novorossiysk.

Omicron COVID-19 Case Estimates Based on Previous SARS-CoV-2 Wastewater Load, Regional Municipality of Peel, Ontario, Canada.

We determined correlations between SARS-CoV-2 load in untreated water and COVID-19 cases and patient hospitalizations before the Omicron variant (September 2020-November 2021) at 2 wastewater treatment plants in the Regional Municipality of Peel, Ontario, Canada. Using pre-Omicron correlations, we estimated incident COVID-19 cases during Omicron outbreaks (November 2021-June 2022). The strongest correlation between wastewater SARS-CoV-2 load and COVID-19 cases occurred 1 day after sampling (r = 0.911). The strongest correlation between wastewater load and COVID-19 patient hospitalizations occurred 4 days after sampling (r = 0.819). At the peak of the Omicron BA.2 outbreak in April 2022, reported COVID-19 cases were underestimated 19-fold because of changes in clinical testing. Wastewater data provided information for local decision-making and are a useful component of COVID-19 surveillance systems.

Disparities among Japanese municipalities in recommendations for routine and catch-up HPV vaccinations.

In November 2021, the government of Japan announced a reversal of its decision in 2013 to suspend the previous proactive recommendation for HPV vaccination. However, the program for young girls to receive routine and catch-up vaccinations has not necessarily developed as expected. We conducted a nationwide questionnaire survey by mail in September 2022. The survey was mailed to 133 municipalities consisting of all cities/wards of the Tokyo and Osaka Prefectures and all other prefectural capital cities. Responses were received from 82 municipalities (62.7%). Notification of routine HPV vaccinations had already been sent to 76 (92.7%) of the municipalities; 70 (85.4%) had been encouraged to promote catch-up vaccinations. The questionnaire forms for registration and pre-vaccination screening for routine immunization had been sent to 74.1% (60/81) of the municipalities and 68.8% (55/80) for catch-up immunizations. For catch-up vaccination, only 54 municipalities (65.9%) had detailed vaccination records for those eligible. In total, 10 municipalities (12.2%) had virtually no vaccination records because these had already been discarded. In addition, 61 municipalities (74.4%) had notified only women and girls eligible for a catch-up vaccination based on their vaccination record, whereas 25.6% (21/82) of the municipalities reported that they had sent, or would send, the notification to all women and girls within the targeted grades, including those who had already been vaccinated with three injections. The survey revealed disparities among the municipalities in their HPV vaccine notification processes. Future research on monitoring HPV vaccination rates and incidence rates of cervical cancer and precancerous lesions in each municipality will be desirable.

Knowledge, attitude and preventive practices of COVID-19 among deaf persons in the Greater Accra region of Ghana.

BACKGROUND: Since the emergence of the COVID-19 pandemic, studies continue to investigate the KAP of COVID-19 among diverse groups. We examined the KAP of COVID-19 among deaf persons living in the Ayawaso North Municipality in Accra. METHODS: A descriptive cross-sectional design was used for this study. Our sample comprised deaf persons registered with the Municipal Directorate. In all, 144 deaf persons were interviewed using an adapted KAP COVID-19 questionnaire. RESULTS: Regarding knowledge, majority of the deaf persons (> 50%) were not in the know of 8 out of 12 items of the knowledge subscale. For attitude, deaf persons (> 50%) showed optimistic attitude in all 6 items of the attitude subscale. Deaf persons "always" practised 5 items and "sometimes" practised 4 items in the preventive practices to COVID-19. A positive moderate and significant correlation existed between the subscales. Regression analysis showed that, a one-unit increase in knowledge will result in a 1.033-unit increase in preventive practices while a one-unit increase in knowledge will result in a 0.587-unit increase in attitude. CONCLUSIONS: Campaigns about COVID-19 should emphasize the teaching of the science of the virus and the disease and not just the preventive practices, paying special attention to deaf persons.

Assessing readiness for childhood obesity prevention in German municipalities: application of the community readiness model.

The World Health Organization has identified childhood obesity as one of the most serious public health problems of the 21st century. Understanding a municipality's readiness to address it is crucial to achieve successful interventions. However, the preparedness of German municipalities to address childhood obesity has not yet been investigated. This study is the first in Germany to apply the community readiness model (CRM) in this context. The purpose was to determine readiness of five municipalities for childhood obesity prevention and to identify factors that influence their readiness. Therefore, 27 semi-structured key informant interviews were conducted. First, the interviews were analysed following the CRM protocol to categorize the municipalities into a readiness level between one and nine. In a second step, a content analysis was carried out for an in-depth interpretation of the readiness scores. The municipalities achieved an average readiness of 3.84, corresponding to the 'Vague Awareness' stage. A lack of prioritization and leadership support, insufficient low-threshold efforts, a lack of knowledge and problem awareness as well as a lack of structures and resources were identified as factors that can determine municipal readiness to prevent childhood obesity. This study not only extends the application of the CRM to childhood obesity in German municipalities but also offers practical implications for professionals in assessing readiness.

Monitoring Sensors for Urban Air Quality: The Case of the Municipality of Lisbon.

Air pollution is a global issue that impacts environmental inequalities, and air quality sensors can have a decisive role in city policymaking for future cities. Science and society are already aware that during the most challenging times of COVID-19, the levels of air pollution in cities decreased, especially during lockdowns, when road traffic was reduced. Several pollution parameters can be used to analyse cities' environmental challenges, and it is more pressing than ever to have city climate decisions supported by sensor data. We have applied a data science approach to understand the evolution of the levels of carbon monoxide, nitrogen dioxide, particulate matter 2.5, and particulate matter 10 between August 2021 and July 2022. The analysis of the air quality levels, captured for the first time via 80 monitoring stations distributed throughout the municipality of Lisbon, has allowed us to realize that nitrogen dioxide and particulate matter 10 exceed the levels that are recommended by the World Health Organization, thereby increasing the health risk for those who live and work in Lisbon. Supported by these findings, we propose a central role for air quality sensors for policymaking in future cities, taking as a case study the municipality of Lisbon, Portugal, which is among the European cities that recently proposed be climate-neutral and smart city by 2030.

´You are not yourself anymore´: The place of the ethical demand in a practical home care context.

THE STUDY'S RATIONALE: The Scandinavian nursing tradition is based on caring science as the ontological backdrop. This means that meeting the patient with openness and respect is essential in care. The experiences of an elderly woman receiving home nursing provide insight into a world many healthcare workers need to understand; meaning what is important in the encounter with the fragile old patient whose voice is not often heard in the society nor in research. Caring science with its person-oriented care clashes with the New Public Management's ideal for municipal health care in Norway, at the expense of the needs of the elderly patients. AIMS AND OBJECTIVES: This article aims to express the phenomenon of lived experience as presented by an elderly woman, more specifically her experience of care in home nursing run according to the principles of new public management. METHODOLOGICAL DESIGN: The article is based on an empirical narrative in the form of an individual qualitative research interview. FINDINGS: The patient has needs that cannot be defined without the nurse having an ethical understanding of what may be important in the patient´s lifeworld. The core findings are: Feeling disregarded as a human being, Broken agreements, Surrendering in anonymous relationships and Each day is a different day with altered needs. CONCLUSION: The system of New Public Management sets a strain on the time at hand for the nurse to develop a relationship that acknowledges and supports the patient´s life courage. The ethical demand and care ethics can explain how the patient´s will to live can be preserved, and provide knowledge of how the caregiver can best attend to the patient's ways of expressing what is important to her. Nevertheless, within the time at disposal, the nurse has an opportunity to either marginalize or strengthen the old person´s dignity.

Health promotion programs for middle-aged adults that promote physical activity or healthy eating and involve local governments and health services: A rapid review.

BACKGROUND: Noncommunicable diseases can be prevented or delayed through health promotion programs. Little is known about programs delivered by partnership organisations that address lifestyle behaviours. The study's purpose was to review the literature on physical activity or healthy eating health promotion programs, delivered in partnership by the local government and local health services, to describe characteristics of programs and their impact on physical activity, healthy eating or related health outcomes among middle-aged adults. METHODS: This rapid review was conducted from November 2021 to June 2022, informed by the Cochrane Rapid Reviews Methods guidance for conducting rapid reviews. Articles published in English since 2000 were identified in Medline, Embase, CINAHL, AgeLine and Scopus databases. A narrative synthesis was performed. RESULTS: Ten articles involving 19 802 participants were identified from a total of 4847 articles identified from the search. The primary role of the partnership was providing funds. Other roles were facilitating stakeholder involvement, program development, delivery and recruitment. Positive outcomes were likely if programs were developed by collaborative stakeholder partnerships, informed by previous research or a behaviour change framework. The heterogeneity of study designs and reported outcomes did not permit meta-analysis. CONCLUSION: This review highlights the lack of evidence of local government-health service partnerships delivering physical activity or healthy eating health promotion programs for middle-aged adults. Programs designed collaboratively with an evidence base or a theory base are recommended and can guide future work investigating strategies for partnership development. SO WHAT?: Physical activity or healthy eating health promotion programs need early stakeholder collaborative input designed with a theory/evidence base. This can guide future work for investigating strategies for partnership development.

Sustainability of drinking water and sanitation delivery systems in rural communities of the Lepelle Nkumpi Local Municipality, South Africa.

Water and sanitation are core for the growth and development of communities. Yet, South African local municipalities are often unable to sustainably deliver safe water and basic sanitation for all. Drawing on perspectives of ecological economics, this study analysed the sustainability of water and sanitation systems in rural communities of the Lepelle Nkumpi Local Municipality. Mixed research approach was used to collect the data from 657 household and institutional respondents. The study found that households used water for multi-purposes including consumptive, productive and domestic, but existing facilities are in deplorable condition. Pollution arising from agrochemicals, waste systems, mining, sewerage, and industrial effluence significantly affected water systems in the communities. Bridging demand-supply gaps require initiatives like bulk water supply and implementation of the free basic water policy in underprivileged areas. Tariffs should either be waived or adjusted for extremely poor households. Waste management initiatives, like capacity building, public education, investments, and facility upgrade, could help avert spread of waterborne infections and improve the resident's health.

Spatial accessibility modeling to healthcare facilities in the case of health shocks of Midnapore municipality, India.

This research aims to identify the accessibility of the entire population, especially the slum population to existing healthcare facilities (HCF) as well as the slum neighborhoods having low geographic accessibility, and finally, to provide an analytical model for the people living in areas that are outside the coverage range of existing healthcare facilities (HCF) across the study area. Spatial data has been collected and used based on the road network, elevation, location of HCF, municipal boundary, slum point, and satellite images from various sources. Also, non-spatial data such as socioeconomic variables are collected from questionnaires survey within a particular period. The spatial analysis tool like as near, network analysis, and predictive analysis in the ArcGIS platform was used to examine geographic accessibility. The results of the spatial analysis show that the distribution of public healthcare facility centers in the study area has not been uniformly distributed. Across 84% of areas in the study area have sound spatial accessibility with traveling time coverage is about 12 min. However, 16% of areas have a traveling time of 12 to 30 min under low accessibility with existing slum neighborhoods. Therefore, the low spatial accessibility areas are demanding new healthcare facilities in the study area. The Analytical Hierarchy Process (AHP) is employed to find the most optimal and efficient locational suitability for building new healthcare facility centers. The finding of AHP analysis for site suitability of healthcare facilities revealed five major classes as most suitable (2%), suitable (5%), moderate (35%), poor (54%), and very poor (4%) in the study area. Moreover, the realistic framework of this study helps to measure geographic accessibility and suitability in any geographical area.