Factors that Affect Access to the Healthcare Services in Rural Areas in the UAE: Hatta Hospital Case Study
Case Study about Hatta Hospital in the UAE
Keywords:Access to the healthcare system, Rural areas, Rural health care, Heath care system, Health services reform, Health services accessibility, Healthcare disparities, Quality, Health Policy
Background: Despite the differences in the type and quality of healthcare services provided in developing and developed countries, there are still several challenges, especially in providing healthcare services in rural and remote areas.
Methods: A qualitative method was chosen for this research. A case study about Hatta Hospital was used to study the barriers and strategies the Dubai Health Authority (DHA) adopted to provide healthcare services for people in rural communities in the Emirate of Dubai.
Results: Many barriers affect the delivery of healthcare services to rural residents. These barriers were summed up as structural, financial, and cognitive barriers. In this study, cognitive barriers, such as health literacy, social stigma, awareness to get the resources, and language, were the main barriers, followed by structural barriers like transportation and availability. The financial barriers were not found to be significant in this case study.
Conclusion: Accessing to healthcare services in rural areas was considered as a common point in all countries worldwide. There were challenges that could block this like structural, financial and cognitive. The situation in the UAE in general and in DHA, in particular, was quite good and moving forward to reduce the gaps between the urban and rural areas in providing healthcare services. The DHA had many strategies that were implemented to provide high quality services not only in Dubai city, but also to its rural areas like Hatta. These strategies included build up a hospital that has all emergency services, affiliation with larger system or networks, improve the employees’ condition and implement and activate using the telehealth.
Al Hammadi, A.H.Y (2018). Leadership, strategic planning, organizational performance, and innovation: a case of Dubai/UAE public sector. Journal: International Journal of Management and Information Technology, 13(1).
American Hospital Association, (2020). TrendWatch: The Opportunities and Challenges for Rural Hospitals. Available at: https://www.aha.org/guidesreports/2011-04-18-trendwatch-opportunities-and-challenges-rural-hospitals. Access on: 22nd March 2020.
Australian Institute of Health and Welfare, (2019). Rural & remote health. Cat. no. PHE 255. Canberra: AIHW. Available at: https://www.aihw.gov.au/reports/rural-remote-australians/rural-remote-health. Access on: 22nd March 2020.
Assistant Secretary for Planning and Evaluation., (2016). Impact of the Affordable Care Act Coverage Expansion on Rural and Urban Populations. Available at: https://aspe.hhs.gov/system/files/pdf/204986/ACARuralbrief.pdf. Access on: 22nd March 2020.
Atkinson, J., (2002). Four steps to analyze data from a case study method. ACIS 2002 Proceedings, p.38.
Bell., G. (2013). Modern UAE health care: From a mud hut to skyscraper hospitals. Available at: https://www.thenational.ae/uae/health/modern-uae-health-care-from-a-mud-hut-to-skyscraper-hospitals-1.300036. Access on: 21st September 2020.
Brant,. S, Garris,. M., Okeke, E., and Rosenfeld. R., (2006). Access to Care in Rural China: A Policy Discussion. University of Michigan School of Public Health.
Brenes, G. A., Danhauer, S. C., Lyles, M. F., Hogan, P. E., & Miller, M. E. (2015). Barriers to Mental Health Treatment in Rural Older Adults. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 23(11), 1172–1178.
Buchan, J., Couper, I.D., Tangcharoensathien, V., Thepannya, K., Jaskiewicz, W., Perfilieva, G. and Dolea, C., (2013). Early implementation of WHO recommendations for the retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 91, pp.834-840.
Campbell., A, Hanania., H, Stenhouse., K and Donev., J., (2020). Rural Population. Available at: https://energyeducation.ca/encyclopedia/Rural_population, Access on: 07th October 2020
Carrillo, J. E., Carrillo, V. A., Perez, H. R., Salas-Lopez, D., Natale-Pereira, A., and Byron, A. T. (2011). Defining and Targeting Health Care Access Barriers. Journal of Health Care for the Poor and Underserved 22(2):562–75.
CDC,, (2019). Telehealth in Rural Communities. Available at: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/telehealth-in-rural-communities.htm. Access on: 24th March 2020.
Cordes, R. and Scholz, F., (1980). Bedouins, wealth, and change; a study of rural development in the United Arab Emirates and the Sultanate of Oman.
Cortelyou-Ward, K., Atkins, D.N., Noblin, A., Rotarius, T., White, P. and Carey, C., (2020). Navigating the Digital Divide: Barriers to Telehealth in Rural Areas. Journal of Health Care for the Poor and Underserved, 31(4), pp.1546-1556.
Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A. and Sheikh, A., 2011. The case study approach. BMC medical research methodology, 11(1), pp.1-9.
Dassah, E., Aldersey, H., McColl, M.A. Davison., C. (2018). Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis. Glob health res policy 3, 36.
DHA, (2020a). Hatta Hospital. Available at: https://www.dha.gov.ae/en/HattaHospital/Pages/Home.aspx. Access on: 24th March 2020.
DHA., (2020b) Hatta Hospital catalogue services. Available on: https://www.dha.gov.ae/Asset%20Library/SC/HOSPITALS/HH/EN.pdf. Access on: 16th December 2020.
DHA., (2020c). Strategic Partners. Available on: https://www.dha.gov.ae/en/Aboutus/Pages/Strategic%20Partners.aspx. Access on: 16th December 2020.
Douthit, N., Kiv, S., Dwolatzky, T. and Biswas, S., (2015). Exposing some important barriers to health care access in the rural USA. Public health, 129(6), pp.611-620.
Embassy of the United Arab Emirates, (2019). Health Care, Available at: https://www.uae-embassy.org/about-uae/health-care. Access on: 14th November 2019
ENAYA., (2014). Government of Dubai Employee Healthcare Benefits Scheme. Available:https://www.dha.gov.ae/en/Documents/enaya/CAT%20VIP%20English%20TOB%202013-2014.pdf. Access on: 18th December 2020.
Fisher., N. (2019). Urbanization Leaves Rural America In A Health Care Crisis. Available at: https://www.forbes.com/sites/nicolefisher/2019/10/25/urbanization-leaves-rural-america-in-a-health-care-crisis/#665125741b2a. Access on: 22nd March 2020.
Freed, C. R., Hansberry, S. T., & Arrieta, M. I. (2013). Structural and Hidden Barriers to a Local Primary Health Care Infrastructure: Autonomy, Decisions about Primary Health Care, and the Centrality and Significance of Power. Research in the sociology of health care, 31, 57–81.
Gerring, J. (2007). Case study research: Principles and practices. Cambridge, New York: Cambridge University Press.
Gideon J. (2007). Excluded from health? Informal workers’ access to health care in Chile. B Lat Am Res.;26(2):238–55
Government. ae, (2019). The Fifty-Year Charter. Available at: https://government.ae/en/about-the-uae/strategies-initiatives-and-awards/local-governments-strategies-and-plans/the-fifty-year-charter, Access on: 24th March 2020.
Halpern, M.T., Alexander, J.A. and Fennell, M.L., (1992). Multihospital system affiliation as a survival strategy for rural hospitals under the prospective payment system. The Journal of Rural Health, 8(2), pp.93-105.
Harrison, H., Birks, M., Franklin, R. & Mills, J. (2017).Case study research: Foundations and methodological orientations. Forum: Qualitative Social Research, 18(1), Art. 19, 34 paras. Retrieved from http://nbnresolving.de/urn:nbn:de:0114-fqs1701195
Hunter-Adams J, Rother HA. (2017). A qualitative study of language barriers between South African health care providers and cross-border migrants. BMC Health Serv Res;17(1):97
Indeed., (2020)., Dubai Health Authority Employee Reviews. Available at: https://ae.indeed.com/cmp/Dubai-Health-Authority/reviews?start=60. Access on: 08th October 2020.
Index Mundi report., (2019). United Arab Emirates - Rural population (% of the total population). Available at: https://www.indexmundi.com/facts/united-arab-emirates/indicator/SP.RUR.TOTL.ZS Access on: 08th October 2020.
Institute for Health Metrics and Evaluation., (2020). UAE. Available at: http://www.healthdata.org/united-arab-emirates. Access on: 08th October 2020.
Ishak, N.M., Bakar, A. and Yazid, A., (2014). Developing Sampling Frame for Case Study: Challenges and Conditions. World Journal of Education, 4(3), pp.29-35.
Khaleej Times., (2017). What to do when you can't pay your Dubai medical bills. Available at: https://www.khaleejtimes.com/news/uae-health/cant-pay-your-medical-bills-in-dubai-heres-a-way-out. Access on: 08th October 2020.
Konnert, C. and Petrovic-Poljak, A., (2014). Barriers to mental healthcare utilization. In The Oxford Handbook of Clinical Geropsychology.
Lu, N., Samuels, M.E., Kletke, P.R. and Whitler, E.T., (2010). Rural?Urban differences in health insurance coverage and patterns among Working?Age adults in Kentucky. The Journal of Rural Health, 26(2), pp.129-138.
Lukens. J., (2016). Freestanding Emergency Departments: An Alternative Model for Rural Communities. Available at: https://www.ruralhealthinfo.org/rural-monitor/freestanding-emergency-departments/. Access on: 22nd March 2020.
MacKinney, A., Coburn, A., Lundblad, J., McBride, T., Mueller, K. and Watson, S., (2014). Access to rural health care–a literature review and new synthesis. Policy Report. Rupri: Rural Policy Research Institute.
Macrotrends., (2020). UAE Life Expectancy 1950-2021. Available at: https://www.macrotrends.net/countries/ARE/uae/life-expectancy#:~:text=The%20current%20life%20expectancy%20for,a%200.18%25%20increase%20from%202018. Access on: 22nd March 2020.
McLeod, S. (2019). Case Study Method. Available at: https://www.simplypsychology.org/case-study.html. Access on: 1st Feb 2021
MBRGS., (2018)., The State of UAE Healthcare Service Delivery: Public Perceptions- Preliminary Insights. Available at: https://www.mbrsg.ae/getattachment/9e9f451a-5d2f-4080-a510-e3232e55df36/The-State-of-UAE-Healthcare-Service-Delivery.aspx. Access on: 19th November 2020.
Medarbia., (2014).Painful gaps in healthcare specialties I Abu Dhabi’s western region. Available at: https://m.edarabia.com/painful-gaps-in-healthcare-specialties-in-abu-dhabi-s-western-region/78008/ . Access on: 19th November 2020.
Memon, Q.A., (2009). Implementing Role Based Access in Healthcare Ad Hoc Networks. J. Networks, 4(3), pp.192-199.
Moffatt, J.J. and Eley, D.S., (2010). The reported benefits of telehealth for rural Australians. Australian Health Review, 34(3), pp.276-281.
Morton, L.W. and Lois, N.E.J., (2004). Critical issues in rural health (Vol. 302). Blackwell Publishing. Wiley-Blackwell.
National UAE, (2011). New health care plan for remote rural areas. Available at: https://www.thenational.ae/uae/health/new-health-care-plan-for-remote-rural-areas-1.416421, access on: 24th March 2020.
NCD Risk Factor Collaboration, (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature, 569(7755), p.260.
Oyeka, O., Ullrich, F. and Mueller, K., (2018). Trends in Hospital System Affiliation, 2007-2016. Rural policy brief, 2018(5), pp.1-6.
Pampalon, R., Martinez, J. and Hamel, D., (2006). Does living in rural areas make a difference for health in Quebec?. Health & place, 12(4), pp.421-435.
Pass LE, Kennelty K, Carter BL. (2019). Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study
Puskin, D.S., (1995). Opportunities and challenges to telemedicine in rural America. Journal of Medical Systems, 19(1), pp.59-67.
Revel, T. and Yussuf, H., (2003). Taking primary care continuing professional education to rural areas: Lessons from the United Arab Emirates. Australian Journal of Rural Health, 11(6), pp.271-276.
Rural Health Information Hub., (2020a) Barriers to Mental Health Treatment in Rural Areas. Available at: https://www.ruralhealthinfo.org/toolkits/mental-health/1/barriers. Access on: 29th March 2020.
Rural Health Information Hub., (2020b) Rural Healthcare Workforce. Available at: https://www.ruralhealthinfo.org/topics/health-care-workforce. Access on: 22nd March 2020.
Santalahti, M., Sumit, K. & Perkiö, M. (2020). Barriers to accessing health care services: a qualitative study of migrant construction workers in a southwestern Indian city. BMC Health Serv Res 20, 619
Sherif, D., (2008). The United Arab Emirates. From charity to social change: Trends in Arab philanthropy, pp.206-229.
Strasser, R., (2003). Rural health around the world: challenges and solutions. Family practice, 20(4), pp.457-463.
Sulemana, A. and Dinye, R.D., (2014). Access to healthcare in rural communities in Ghana: a study of some selected communities in the Pru District. European Journal of Research in Social Sciences, 2(4).
The National., (2011). New health care plan for remote rural areas. Available at: https://www.thenational.ae/uae/health/new-health-care-plan-for-remote-rural-areas-1.416421. Access on: 08th October 2020.
The Official portal of the UAE Government., (2020a)., UAE Economy. Available at: https://u.ae/en/about-the-uae/economy. Access On: 01st May 2020.
The Official portal of the UAE Government., (2020b)., Infrastructure and Vision 2021. Available at: https://u.ae/en/information-and-services/infrastructure/infrastructure-and-vision-2021. Access On: 01st May 2020.
Trading Economics, (2020a). United Arab Emirates GDP per capita. Available at: https://tradingeconomics.com/united-arab-emirates/gdp-per-capita . Access on: 11th November 2020.
Trading Economics, (2020b). United Arab Emirates - Rural Population. Available at: https://tradingeconomics.com/united-arab-emirates/rural-population-percent-of-total-population-wb-data.html. Access on: 24th March 2020.
United Nation., (2018). 68% of the world population projected to live in urban areas by 2050. Available at: https://www.un.org/development/desa/en/news/population/2018-revision-of-world-urbanization-prospects.html#:~:text=The%20global%20rural%20population%20is,by%20China%20(578%20million). Access on: 08th November 2020.
U.S. Census Bureau., (2019). Health Insurance Coverage in the United States, 2018. Available:https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf. Access on 08th November 2020.
Wagstaff, A., Bustreo, F., Bryce, J., Claeson, M. and Who–World Bank Child Health and Poverty Working Group, (2004). Child health: reaching the poor. American journal of public health, 94(5), pp.726-736.
Williams, J., Song, P. and Pink, G., (2015). Estimated Costs of Rural Freestanding Emergency Departments. Chapel Hill, NC: North Carolina Rural Health Research Program.
WHO., (2006). Health System Profile of United Arab Emirates. Available at: https://www.researchgate.net/publication/322891992_Interethnic_Variations_and_Clinical_Features_of_Spondyloarthropathies_in_a_Middle_Eastern_Country/fulltext/5a7466c6aca2720bc0dcfa96/Interethnic-Variations-and-Clinical-Features-of-Spondyloarthropathies-in-a-Middle-Eastern-Country.pdf. Access on 22nd September 2020.
WHO., (2010). Increasing access to health workers in remote and rural areas through improved retention. Available at: https://apps.who.int/iris/bitstream/handle/10665/44369/9789241564014_eng.pdf?sequence=1 . Access on: 24th March 2020.
WHO., (2016). United Arab Emirates. Available at: https://www.who.int/nmh/countries/are_en.pdf. Access on: 08th October 2020.
Yin, R. K. (2014). Case study research: Design and methods (5th Edition). London: SAGE
Zacharias., A. (2011). New health care plan for remote rural areas. Available at: https://www.thenational.ae/uae/health/new-health-care-plan-for-remote-rural-areas-1.416421. Access on: 22nd September 2020.
Zawya., (2020). Hatta Hospital's laboratory receives CAP accreditation. Available at: https://www.zawya.com/mena/en/press-releases/story/Hatta_Hospitals_laboratory_receives_CAP_accreditation-ZAWYA20180510115900/. Access on 22nd September 2020.
How to Cite
Copyright (c) 2023 Journal of Health Informatics in Developing Countries
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.Authors retain copyright of the submission while granting the journal the right to publish it in the journal and in print.