A qualitative study of accessibility health services among communities on small Islands in Makassar city

Abstract

This study aims to explore barriers to access in health services among small islands in Makassar City. This research is qualitative research through content analysis by observing phenomena that occur based on the accessibility framework of Levesque, et.al. Data collection was carried out through in-depth interviews with 8 key informants and 9 other informants (n = 17). This study found that geographical factors (distance, travel time, and transportation costs) were the main considerations in utilizing primary health services in the small island communities around Makassar City which were predominantly fishermen. The two closest islands (Barrang Caddi and Bone Tambung), have enjoyed easy access and free service for Universal Health Coverage (UHC) achievements. It is different from the outer islands, especially Langkai and Lanjukang, although most of the residents already have National Health Insurance (NHI) they have difficulty using their cards due to geographical constraints. Moreover, fishermen often go fishing for days, becoming another obstacle in accessing quality health facilities available in Makassar City. Various efforts have been made by the Makassar City Health Office to address the disparity in health services in the islands in Barrang Caddi, such as the use of sea ambulances, and regular visits. The marine ambulance is only one ship on standby between two public health centers in another village office if there is an emergency patient who must be referred to a hospital in Makassar City. This disparity in access to health services triggers injustice among residents of the islands in the Makassar City area. Very contractual with the slogan: “Makassar City of the World”. This study revealed a special transportation need in the form of a very simple capacity sea ambulance and managed by island community communities that are not reached by sea ambulances from the public health center.