Geographical aspects of health and use of primary health care services in Jeddah, Saudi Arabia
This thesis examines the contribution that geographical analysis can make to the study of the variation in the patterns of human health and subsequently to the discussion on the type and level of use of the public health service in a rapidly developing country. The current study was conducted in Jeddah Governorate, Kingdom of Saudi Arabia during the period 1994 and 2000. One of the main aims was to examine the pattern of health services provided in Saudi Arabia and this aim was achieved by investigating the provision and use of the Public Healthcare services. An attempt was made to clarify the complex web of relations that existed between, on the one hand, the different socioeconomic and geographic factors and on the other, the distribution of common ailments together with the level of utilization of health services. Shortcomings in the nature of the official health statistics regarding socioeconomic conditions of the patients were remedied through the use of a questionnaire. A tot al of 1000 patients from the eight PHCCs were surveyed for their use of the public health service. Data was collected from the same patients on their socio-economic, education and habitation details. This sample was used to supplement the data collected from the official government health statistics. These two data sets permitted an evaluation of the occurrence of different ailments and the variations in geographic distribution among the eight selected PHCCs. Difficulties persisted in the availability of official 1992 census data until publication of census data became available in 1999. In contrast to the problems of the census data, the availability of accurate and up-to-date patient records compiled by Ministry of Health staff was of considerable benefit to this research project. Use was made of Geographic Information Systems software for the analysis of data collected at the level of the PHCC. This allowed visual identification of the spatial variation in the use of the different health services and also allowed the identification of gaps in healthcare provision. The study showed that a density of habitation index used as a prime indicator of socio-economic status could be used as an indicator of the occurrence level for a number of common diseases. A pattern of disease was observed that suggested that the number of visits to PHCCs was substantially higher in low socio-economic districts compared to medium and higher socio-economic districts. It can be shown that the most common ailment was Upper Respiratory Tract Infections followed by Dental and Gingival diseases. Persons aged between 15 and 44 years made most visits to PHCCs although children under 15 years made proportionately greater use of PHCC facilities. No difference could be found between Saudi and Non Saudi as regards the occurrence of the most common ailments and diseases. The lack of difference was probably due to the close integration of the two population groups and the sharing of the same local environment. This similarity occurred despite considerable differences in income levels and socio-economic status. The level of utilisation of health centers in the selected districts showed differences, being higher in those districts categorized as low socio-economic in the south of Jeddah when compared to higher socio-economic districts in the north of the city. It was evident that the difference in socio-economic factors had an impact on the occurrence of some frequently occurring diseases e.g. URI, Dental, Ophthalmic, musculoskeletal and skin diseases. Although not primarily concerned with private health care facilities, for completeness sake some information was collected on the use of private health care in conjunction with public health care facilities. The author was surprised to discover that greatest use of private facilities occurred among women and children patients from Al Nuzla al Yamaneyyah and Al Thaalebah, districts that were characterised by low socio-economic conditions. The use of traditional folk healing was also briefly studied as this form of treatment remains important for some patients. Results showed that there was no difference between the educational standards of patients and their use of traditional folk healers. Again, children and women constituted the majority (86.6%) of users of traditonal healing with Saudi users (18.9%) higher than non Saudi (11.4%). There remains the supposition that alternative medicine may be of far greater importance than the sparse official data suggests. The unquantified illegal immigrant population may be totally reliant on unofficially operating alternative medicine centres. The thesis concludes by recommending a number of improvements to the existing public health care system. Some changes in the policy and practice of PHCC services will inevitably require more financial resources. These include an extension of the opening times of PHCCs and an increase in the number of specialist facilities such as dental surgeries. Other changes may not require more finances. These include a strengthening of communication and co-operation between PHCCs and hospitals to improve the referral of patients. Expansion of the existing computer network connecting PHCCs with hospitals should be given high priority.