Program Logic model

Simsek, Z., Koruk, I., Doni, N.Y. (2012).  An operational study on Implementation of Mobile Primary Healthcare Services for Seasonal Migratory Workers, Turkey.  Maternal Child Health Journal. (16), 1906-1912.

DOI 10.1007/s10995-011-0941-3

An operational study on Implementation of Mobile Primary Healthcare Services for Seasonal Migratory Workers

This operational study was on Migratory farm workers and their families. It was conducted in Sanhurfa, Turkey, the province with the highest rate of seasonal farm workers. The research was conducted to investigate the health status of migrant farm working women and their children and improve healthcare access for this population. Women farm workers are less likely seek healthcare during pregnancy, resulting in improper prenatal care, unintended abortions, increased number of stillbirths, and complications during delivery.  This also correlates to decreased levels of childhood vaccinations and higher prevalence of diseases in children in these families. .

The study took place from March 2008 to April 2009 and consisted of a two-part health evaluation on maternal and child health.  The initial assessment was done by visiting the permanent residence of the women farm workers. Physical assessments and interviews were conducted to obtain information regarding health status and practices. During this first stage, 580 women and 336 children were screened. The second health evaluation was done in the temporary work setting, in which 85 living units were assessed.  257 women and 217 children were evaluated.

The main purpose of this study was to develop a method in which primary healthcare services could be provided for mothers and children in seasonal farm working jobs. Health status of this particular group is particularly under-deserved due to unhealthy working and living conditions, leading to increased barriers in accessing healthcare services.  The study targeted women of reproductive age (15-49) and children (0-5). This group of population is known to have low-parental education, large household sizes, higher number of children, and higher levels of poverty, which contributes to health inequities.

Mobile Primary Healthcare Services was designed using a quasi-experimental study approach. Each participant served as their own control, baseline and outcome variables were measured, and interventions were applied, and were then followed up with results and outcome variables. The selected health outcomes include full childhood and tetanus vaccinations, phenylketonuria screening in pregnant women, safer usage of pesticides, iodine salt usage, toilet facilities, and use of safe water storage using chlorine tablets.

In determining the most effective way to reach and target this population, a community health organization approach was utilized to most appropriately develop a strategy for solution to this problem.  The stakeholders (community members, farmworkers, municipality staff, and settlement managers) were involved in the process of identifying a solution.  Mobile primary health services were chosen as the most effective, sustainable way to provide preventative healthcare to this target population.

The data collected was quantitative and was analyzed using the SPSS windows 11.0.  Descriptive and inferential statistics were used to summarize the demographics characteristics and pre and post data. Chi-Square test was used to analyze different health indicators.

The results of this study and implementation of MPHS showed significant improvement in health status in both maternal and child health. Age appropriate vaccination increased from 44% to 75.2%, Tetanus vaccinations increased from 20.4% to 73.9%, and phenylketonuria screening increased from 40.4% to 100%.  Overall health education on safe pesticide use increased and there was increased awareness on good health practices. It was deemed that MPHS were the most appropriate and efficient ways to target migratory farm workers and their families and provide preventative health services, to improve health outcomes and reduce disparity amongst this medically under deserved population.  The implementation of the MPHS eliminates the barrier for healthcare seeking because of the convenience provided by it. This study confirms that the use of this model is very effective in getting this population to participate in health screenings, contributing to better health outcomes. This study was the first operational study that targeted seasonal workers. The results of this study were then used to impact public health policies to further implement nation wide attempts to target this portion of the population.

There are many barriers that migrant workers face, such as excessive mobility due to the seasonal work. Many of them live at their permanent addresses for only 4 months, leaving them living in tents on working settlements for 8 months out of the year. To compensate for this barrier, this program implanted MPHS so that these individuals can access healthcare services at their convenience. Health screenings are done one site where vaccinations and health education is also provided at the time. As linguistic barriers are also a major issue for farmworkers in accessing health services, the MPHS included a team of health professions (nurse, doctor, midwife) who were trained to meet the health related needs of these farm workers and are equipped to meet the standards this undeserved population.

Making healthcare services accessible and convenient to use by vising their work settlements made them more likely to use these services. With developing countries over the years, healthcare services being provided has been compromised due to conflict, poor governance, and disinvestment in health. This leads to marginalization and isolation of certain groups within the society, who are affected most by these governance and public policies. The MPHS attempts to fill this gap within rise population by increasing preventative measures and strengthening the public health infrastructure of this group.

This study is important and relevant to our research topic Salud because it encompasses the migrant farm working population and utilizes Mobile Healthcare Services to provide health services to this population. The program, Salud, focuses on primarily winery workers and their families as where this program focused primarily on maternal and child health.