Barriers to the uptake of community-based curative child health services in Ethiopia.
Barrier analysis
Community-based newborn care
Ethiopia
Health extension program
Health extension workers
Integrated community case management
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
14 08 2021
14 08 2021
Historique:
received:
23
06
2020
accepted:
27
07
2021
entrez:
15
8
2021
pubmed:
16
8
2021
medline:
15
9
2021
Statut:
epublish
Résumé
Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs' confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.
Sections du résumé
BACKGROUND
Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project.
METHODS
Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions.
RESULTS
Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs' confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services.
CONCLUSION
This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.
Identifiants
pubmed: 34391398
doi: 10.1186/s12889-021-11558-2
pii: 10.1186/s12889-021-11558-2
pmc: PMC8364059
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1551Informations de copyright
© 2021. The Author(s).
Références
Ethiop Med J. 2014 Oct;52 Suppl 3:109-17
pubmed: 25845080
BMC Pediatr. 2013 Dec 01;13:198
pubmed: 24289501
Ethiop Med J. 2014 Oct;52 Suppl 3:15-26
pubmed: 25845070
Afr J Tradit Complement Altern Med. 2008 Jun 18;5(4):380-6
pubmed: 20161960
Health Policy Plan. 2016 Jun;31(5):656-66
pubmed: 26608585
Am J Trop Med Hyg. 2014 Aug;91(2):424-434
pubmed: 24799369
J Glob Health. 2014 Dec;4(2):020410
pubmed: 25520800
Am J Trop Med Hyg. 2016 Mar;94(3):596-604
pubmed: 26787148
Hum Resour Health. 2014 Oct 14;12:61
pubmed: 25315425
BMC Res Notes. 2014 Oct 08;7:705
pubmed: 25297952
Ethiop Med J. 2014 Oct;52 Suppl 3:157-61
pubmed: 25845085
Lancet. 2016 Dec 3;388(10061):2811-2824
pubmed: 27072119
BMC Health Serv Res. 2017 Mar 9;17(1):184
pubmed: 28274261
Ethiop Med J. 2014 Oct;52 Suppl 3:47-55
pubmed: 25845073
Am J Trop Med Hyg. 2015 Sep;93(3):636-647
pubmed: 26195461
J Midwifery Womens Health. 2014 Jan;59 Suppl 1:S110-7
pubmed: 24588912