Tackling the Urban-Rural Health Care Divide: A Lesson from Israel’s Periphery

For those who live on Israel’s periphery, a simple trip to the hospital can be a recipe for disaster. Accessing the nearest emergency center can take more than an hour on rural, winding roads. Once inside, patients encounter emergency rooms overcrowded by up to 300 percent— many packed eight to a room – while the smell of unchanged sheets hangs in the air.[1],[2] Stretchers line hallways. Overworked doctors and nurses run between beds.[3]

There are dramatic differences in health outcomes between those who live in most of central Israel and those on the country’s northern and southern periphery. According to the Israeli Medical Association, life expectancy on the periphery is several years shorter. The rates of infant mortality are more than twice as high.[4] Although not the only factor, health care access is a major driver of this discrepancy. The periphery regions have nearly half as many hospital beds per capita, double the emergency room wait times, and far fewer medical specialists.

Addressing the disparity is a multi-faceted challenge that will require a basket of solutions. One potential solution has come to light in the form of a unique model for health- and home care supportive services, which was recently introduced in Israel’s Southern periphery by a volunteer-led non-profit health care organization known as Yad Sarah. Through its “Home Hospital” program, Yad Sarah lends out medical equipment, from hospital beds and hoists to wheelchairs and oxygen tanks. The program was designed with a simple goal in mind: whenever possible, enable the elderly, injured, and sick to receive care at home—not in a hospital. By facilitating timelier discharges of patients, the program promises to reduce pressure on overwhelmed hospitals and ensure that beds are available for those with greatest need.

Yet, for the thousands of homebound people living  in Israel’s periphery, barriers to healthcare go beyond overcrowding.  For the  homebound, elderly, and disabled living in dispersed and isolated communities, it can be impossible to make the trek from their homes for something as fundamental as a medical checkup or dentist appointment. To accommodate those on the periphery with no recourse for care, Yad Sarah developed a strategic partnership with The Leona M. and Harry B. Helmsley Charitable Trust. It is now offering a mobile dental clinic, with dentists that travel – tools in tow – to provide affordable, in-home dental care to patients in need on Israel’s northern and southern peripheries.

Unburdened by the bureaucracy and red tape of government sponsored programs, nonprofits like Yad Sarah are able to move uniquely nimbly and effectively, taking on seemingly intractable problems in a way that the public sector often cannot.

As other countries wrestle with how to provide health services to citizens, particularly those living in rural areas with insufficient transportation networks, Yad Sarah offers a model for delivering better care to vulnerable populations. According to the United Nations International Labor Organization, while half of the world’s population lives in rural areas, only 23% of the global healthcare work force is deployed there.[5] Programs like Yad Sarah’s, operating in rural communities around the world, could be deployed to provide assistance and medical equipment to even the most isolated and vulnerable regions.

Why is this model particularly effective? It strengthens existing support systems in a local community to better serve those who have fallen through the cracks of traditional health care. The volunteer-run and local nature of such a program enables those already integrated into the community to provide care more effectively and economically than could be achieved by the state alone.

Addressing issues like rural health disparities requires systematic change in complex social institutions. Most often, government cannot achieve this change on its own. The public must work hand-in-hand with nonprofits, learning from their failures and adopting and expanding upon their successes. Strategic partnerships with local, grass roots organizations like Yad Sarah’s allows those most underserved by traditional health care programs to get the help they need without straining limited government resources. Governments can build off nimble, innovative initiatives spearheaded by non-profits to address the needs of the most vulnerable and often forgotten members of society, offering support to the bed bound, treatment to the infirm, and care for the disabled.

Adele Goldberg is the Executive Director of Friends of Yad Sarah.   






About the Author
Adele Goldberg is the Executive Director of Friends of Yad Sarah, which raises much-needed funds to support the work of the Yad Sarah organization and its dedicated corps of volunteers in Israel.
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