CHAPTER 2

RELATED LITERATURE AND STUDIES

This research study cited books, and articles that are significant to the investigation at

topic. It is made up of local and international literature and studies that include facts and

information on the study subject at hand. It also explains current research and draws logical links

between itself and the recent work.

REVIEW RELATED LITERATURE

HEALTHCARE IN TOWN

John Ryan Santos (2019) quoted, “Despite their large numbers, CAHs face major

challenges that threaten their long-term viability. These challenges included payment

mechanisms, quality, access to capital, and a skilled workforce. COVID-19 also presents new

challenges, such as redundant plans for these communities, a lack of public health infrastructure,

and the inherent variability resulting from citizens creating individual care plans. To maintain

CAHs (Critical Access for Hospitals) over the next decade, additional policy interventions will

be required to address or mitigate the challenges in each of these areas.”

A healthcare project is a compact hospital model with a test site that is intended to serve

as a template for a network of compact hospitals that will be built in rural municipalities

throughout the Philippines in the future. Moreover, he also said that unlike in developed

countries, where hospitals are well-funded, small towns must fund their own hospitals, which

means they must be extremely efficient in their planning to provide the critical service
capabilities of a tertiary hospital at a cost that is not prohibitive to investors. Simultaneously,

they must be disaster-resilient, as we are one of the world's most disaster-prone countries.

As specified by (,2021) Having access to healthcare services is critical for maintaining

good health, but rural residents face a variety of challenges in obtaining these services. Ideal

residents should be able to access services such as primary care, dental services, behavioral

health services, emergency care services, and public health services in a convenient and

confident manner.

Rural residents frequently encounter barriers to healthcare that make it difficult for them

to receive the treatment they require. A timely availability and accessibility of necessary and

appropriate healthcare services for rural residents is required in order to ensure that they have

enough access to care. If a sufficient supply of healthcare services is available in the community,

there are additional considerations to be made in terms of healthcare access.

For instance, a rural resident must have financial means to pay for services, such as

health or dental insurance accepted by providers, confidence in their ability to communicate with

healthcare providers, particularly if they are not fluent in English or have poor health literacy.

Confidence in using services without jeopardizing privacy and receiving quality care.

CHALLENGES FOR RURAL HEALTH CARE

According to (Nortje et al., 2021) rural health care delivery faces a variety of challenges

that go beyond simple issues such as low population density, geographic isolation, and
accessibility. According to research, rural areas face a variety of structural challenges. For rural

hospitals, these difficulties can make managing critical patients, tracking strategic reserves of

supplies, and defining specific pathways for care significantly more difficult. This means that

they will not always be able to turn to best practice literature and find solutions that are

appropriate for their situation. Aside from that, rural areas face several geographical, which are

exacerbated by extreme weather condition. The safe and timely transportation of patients to

tertiary care facilities can be jeopardized by such circumstances. It is not always possible to rely

on reliable internet and even phone connections. As a result, even basic communication with and

between members of the community may be difficult.

To 'flatten the curve,' hospitals and health-care providers have been frantically attempting

to do so for months. But there are valid fears regarding the possibility of future pandemic waves.

Many countries that were previously trying to balance competing demands for cost, quality,

sustainability, comprehensiveness, and continuity of care may now find themselves in an even

more difficult position to do so. The rural context in which concerns are addressed differs from

the urban environment. If you live in a rural place with insufficient resources, these metrocentric

frameworks may be unproductive. Another advantage of living in a rural town is that everyone

seems to know everyone. Ethics judgments in rural health care are rarely abstract; they

frequently have an impact on relatives, neighbors, and coworkers as well as the patients and their

families. Provider-patient interactions can be maximized by using a decision-making framework

and a collaborative strategy when dealing with challenging and unexpected situations, as a result

of this. During the COVID-19 pandemic, health care systems, hospitals, and health-care

providers around the world are being tasked with making ethically sound decisions in the face of

unprecedented circumstances. These difficulties are exacerbated by the everyday realities of rural
environments, where financial, resource, and staffing constraints were already having an impact

on the delivery of basic health care services. Strategic and collective approaches, on the other

hand, may have the potential to maximize efforts and outcomes in rural settings.

As specified by (Slonim, 2020) Pandemic emergencies are large-scale outbreaks of

infectious disease that have the potential to significantly increase morbidity and mortality over a

wide geographic area while causing significant economic and social disruptions as well as

political upheaval. Changing practice standards and shifting the balance of ethical concerns to

emphasize the needs of the community rather than the needs of the individual are justified in

public health emergencies. Changing practice standards and shifting the balance of ethical

concerns to emphasize the needs of the community rather than the needs of the individual are

justified in public health emergencies.

Despite their large numbers, CAHs (Critical Access for Hospitals) face major challenges

that threaten their long-term viability. These challenges included payment mechanisms, quality,

access to capital, and a skilled workforce. COVID-19 also presents new challenges, such as

redundant plans for these communities, a lack of public health infrastructure, and the inherent

variability resulting from citizens creating individual care plans. To maintain CAHs over the next

decade, additional policy interventions will be required to address or mitigate the challenges in

each of these areas. To ensure that CAHs meet the intent and purpose of the Balanced Budget

Act of 1997, several goals must be achieved. First, rural communities must have access to

excellent health and hospital care that addresses the ongoing and evolving COVID-19
challenges. Second, CAHs must have access to capital, technology, and a skilled workforce in

order to provide the level of excellence expected. Finally, compared to the US health system,

these hospitals should not be more expensive to run. Any new policy revisions or

recommendations must establish a net neutral cost structure. After all, the status quo was simply

not sustainable prior to COVID-19 and may be insurmountable after COVID-19.

TELEMEDICINE IMPLEMENTATION

According to (Sedavia et al., 2020) Technology innovation has emerged as a new area of

concern in the context of global pandemic response, especially among third world countries like

the Philippines where technology has not been extensively implemented. Due to the increasing

demand in the healthcare industry, telemedicine will help employees meet the needs of those in

need. Telemedicine is the use of information and communication technology to allow a physician

located elsewhere to access a patient's data.

Asia Pacific had the world's largest internet user population in 2019, with 2.3 billion

users. The Philippines is ranked 12th among countries with the most internet users as of June

2019. In the Philippines, social media users increased to 76 million. On the other hand, the

digital population is primarily composed of people aged 16 and above, and another statistic

indicated that Filipinos spend the most time online and on social media in comparison to the rest

of the world. The Department of Health (DOH) used mobile phone technology to conduct a

national survey on non-communicable diseases (NCDs). According to the health secretary of the

Department of Health, the data will establish a national baseline for prevention strategies.
 With the occurrence of the problem in the Philippines, this study aims to innovate the

current telemedicine application in order to assist residents of an urbanized community in the

Philippines in gaining easy access to proper medication and consultation with doctors regarding

their physical health during the COVID-19 pandemic. This will be accomplished using system

architecture, a house of quality (HOQ), and multiple regression analysis. The study's objective is

to achieve 75% (75%) of the target, focusing on the ratio of health centers per urbanized

community and the implementation of telemedicine. The study will concentrate on a single (1)

urbanized community in the Philippines and will assume that all urbanized communities in the

country face the same problem. Additionally, this study will not address health care providers, as

they are not the subject of this study.

As specified by (Sanmorino & Gustriyanyah, 2019) this study discusses how to improve

community health center services by using e-Notification architecture. The e-Notification can be

used to deliver regular information like vaccination schedules and repeat visits for pregnant

women.

Using e-Notification can save time when broadcasting information simultaneously or personally.

It is possible to send large numbers of notifications simultaneously using the proposed e-

Notification architecture. This proposed architecture can be used in rural or remote areas. This

architecture is still in the design phase and has not been thoroughly tested. However, when

compared to other methods of delivering information, the architecture we submitted takes less

time.
 The Community Health Center (CHC) is a hub for empowering communities, families,

and first-level health services to improve the quality of their services by providing relevant,

timely, and targeted information to patients. In order to reduce infant/toddler mortality, this study

focuses on increasing the percentage of CHC services to patients (especially pregnant women)

through notification services related to pregnancy control schedules and family planning, as well

as reminder services for various types of immunizations. Using the SMS-Gateway Service, the

cost of sending short messages for notifications or reminders made by back-end applications will

be reduced. This back-end application will automatically send SMS notifications to pregnant

women or family planning services. This app will also remind patients to get immunizations,

especially pregnant women, infants/toddlers, and children, to help reduce the high infant/toddler

mortality rate. The proposed e-Notification architecture can help CHC improve their services by

providing timely and targeted information to patients/communities via SMS. This e-Notification

can automatically notify pregnant women or family planning services. E-Notification can also

remind patients to get immunizations, especially pregnant women, infants/toddlers, and children,

to reduce infant/toddler deaths.

IMPROVISATION ACCESS TO RURAL HEALTHCARE

According to the (Community Health Workers in Rural Settings, 2019) rural areas with

limited access to healthcare, particularly those with healthcare that is individualized and

culturally competent, are particularly in need of this type of service. When it comes to ethnicity,

socio-economic status, and language, community health workers (CHWs) are frequently like the

people they serve. While community health workers (CHWs) have traditionally been employed

to work with minority populations, the number of CHWs employed has increased significantly in
recent years, and they now serve a diverse range of rural, urban, and underserved communities.

CHWs in rural areas strive to improve healthcare outcomes by making it easier for people to get

access to care.

This topic guide contains resources that describe different community health worker

models, demonstrate effective community health worker programs, and outline the issues and

challenges associated with the development of community health worker programs. Increasing

the value of the healthcare team and improving the quality of life for people who are poor,

underserved, or from minority communities are two important goals. CHWs serve as a point of

contact between service providers and consumers in both rural and urban settings. The services

that CHWs provide include culturally appropriate health and prevention education, referrals to a

wide range of health and social services, assistance in navigating the health care system and in

coordinating care, advocating for individuals and communities within the health care system,

tracking progress in managing chronic conditions and achieving health goals, and tracing the

progress of individuals and communities within the health care system

As specified by the (Module 6: Funding and Sustainability for Rural Community Health

Worker Programs, 2019) rural communities may want to consider a variety of sustainability

strategies to help them support community health workers (CHW) programs. Obtaining long-

term sustainability frequently necessitates a combination of private and public funding sources.
 In order to sustain improvements in population health, one strategy is to develop or

identify funding models that support population health. Local governments in rural areas should

consider developing a financial plan to bill for health promotion/disease prevention services.

Among the important strategies for achieving sustainability are the following:

 Partnerships must be strengthened in order to have the greatest impact on rural

communities. Creating synergy between organizations with similar goals has the potential

to raise program visibility and emphasize the importance of health messages.

 Educating program staff to specific levels of proficiency ensures that the skills and

knowledge required to improve community health and wellness are available. A train-the-

trainer model ensures that the knowledge and skills gained from trainings are shared and

retained in communities.

 Diversifying funding sources: To ensure long-term sustainability, programs should be

funded from multiple sources. A project can be funded by revenue or reimbursement,

leveraging existing resources, grants, or fundraising. Some rural programs charge

participants or employers to recoup costs.

 Evaluation findings can help determine which program elements should be maintained

and by whom. Others opt for sustainability plans that reduce operations, program

participants, and services or delegate responsibilities to willing coalition members.

 Communicating effectively can have a long-term impact on health issues by raising

awareness and encouraging people to rethink their actions.

COVID-19 QUALITY IMPROVEMENT

 According to the study of (Bakri, 2020). During the COVID-19 Pandemic, this article

describes the management of community health centers, community health efforts, individual

health efforts, and infection prevention and control. The method used is a literature search and

rule and regulation studies. In addition to adjusting efforts or activities, the Quality Improvement

of Service Centre for Community Health in the Pandemic Era COVID-19 also needs to adjust

resource management. Even though each community health center has unique challenges based

on the number of COVID-19 cases in their area. The community health center and the Health

Office must actively follow the development of these changes from official sources so that they

can be immediately adapted to the protocol of services to be provided.

A community health center is a comprehensive health service that interacts directly with

the community and includes activities such as promotion, prevention, curative, and rehabilitative

efforts. Indicators of success in handling COVID-19 in the working area have been developed,

such as - Percentage of OTG (People without symptoms), ODP (People in Oversight), PDP

(Patient in Oversight) that have been found, percentage These indicators are monitored and

controlled monthly. the regional and state budgets, as well as other legitimate sources that are

used in accordance with applicable regulations, to fund the implementation of services during the

COVID-19 pandemic. Management of Community Health Centers is being implemented. The

community health center adjusts other resource management, particularly human resources, in

addition to adjustments related to the efforts or activities to be carried out as well as funding to

be carried out. Service Quality Improvement in the Pandemic Era COVID-19, adjustments were

made to efforts, activities, and funding, as well as resource management. Even though each

community health center has unique challenges based on the number of COVID 19 cases in their
area. Services can be developed by following official and accountable guidelines such as those

issued by certain programs. Because science related to the COVID-19 pandemic is evolving,

policies and guidelines may change. The community health center and the Health Office must

actively monitor this change from official sources to immediately adjust the service protocol.

Increasing staff competency in COVID-19 services and the Priority Programmed is urgently

required.