A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program.
A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program.
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DOI：
10.1016/j.socscimed.2017.01.059
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发表时间：
2017-04
期刊：
影响因子：
--
通讯作者：
Stuckler D
中科院分区：
文献类型：
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作者：
Vellakkal S;Reddy H;Gupta A;Chandran A;Fledderjohann J;Stuckler D
并不是所有符合条件的妇女都使用印度Janani Suraksha Yojana （JSY）提供的服务，该计划提供现金奖励，鼓励孕妇在分娩时使用机构护理；有关需求侧因素与低计划吸收率相关的证据有限。本研究探讨了妇女和社区卫生工作者对使用JSY和机构分娩护理设施的看法。深入的定性访谈于2013年9月至11月进行，由训练有素的采访者以当地语言完成，共有112名参与者，包括JSY用户/非用户和来自贾坎德邦、中央邦和北方邦的asha。探讨了妨碍和促进因素对利用机构护理进行分娩的相互作用。我们发现，asha的支持服务（例如，安排运输、护送和支持医疗机构）和对机构医疗保健好处的认识成为主要的促成因素。JSY现金奖励作为促成因素的作用较小，因为使用保健设施分娩比在家分娩的机会成本更高。最普遍的阻碍因素是对传统助产士技能的信任以及分娩是不需要医疗保健的“自然事件”的观念。认为只有在出现分娩并发症的情况下才需要保健设施的看法也非常普遍。这往往导致等到分娩的最后一刻才寻求机构保健，导致运输服务延误/无法提供，无法及时到达分娩设施。亚洲卫生协会认为，通过人际沟通提高认识对机构保健的使用有更大的影响，而补充性现金奖励进一步鼓励使用。改善以边缘化人群为重点的卫生工作者的支持服务，以及改善公共卫生保健设施，可能会促进在资源贫乏环境中接受机构提供的护理。现金奖励不是获得机构提供保健的关键促成因素。社区卫生工作者的支助服务是一个主要的促成因素。高机会成本（货币和实际）是一个关键的阻碍因素。对卫生服务质量和社会文化观念的怀疑是阻碍因素。
Not all eligible women use the available services under India's Janani Suraksha Yojana (JSY), which provides cash incentives to encourage pregnant women to use institutional care for childbirth; limited evidence exists on demand-side factors associated with low program uptake. This study explores the views of women and ASHAs (community health workers) on the use of the JSY and institutional delivery care facilities. In-depth qualitative interviews, carried out in September-November 2013, were completed in the local language by trained interviewers with 112 participants consisting of JSY users/non-users and ASHAs in Jharkhand, Madhya Pradesh and Uttar Pradesh. The interaction of impeding and enabling factors on the use of institutional care for delivery was explored. We found that ASHAs' support services (e.g., arrangement of transport, escort to and support at healthcare facilities) and awareness generation of the benefits of institutional healthcare emerged as major enabling factors. The JSY cash incentive played a lesser role as an enabling factor because of higher opportunity costs in the use of healthcare facilities versus home for childbirth. Trust in the skills of traditional birth-attendants and the notion of childbirth as a ‘natural event’ that requires no healthcare were the most prevalent impeding factors. The belief that a healthcare facility would be needed only in cases of birth complications was also highly prevalent. This often resulted in waiting until the last moments of childbirth to seek institutional healthcare, leading to delay/non-availability of transportation services and inability to reach a delivery facility in time. ASHAs opined that interpersonal communication for awareness generation has a greater influence on use of institutional healthcare, and complementary cash incentives further encourage use. Improving health workers' support services focused on marginalized populations along with better public healthcare facilities are likely to promote the uptake of institutional delivery care in resource-poor settings. Cash incentive is not a key enabling factor to accessing institutional delivery care. Community health workers' support services is a predominant enabling factor. High opportunity costs (monetary and real) is a key impeding factor. Skepticism about health service quality and socio-cultural notions are impeding factors.