Navigating multiple options and social relationships in plural health systems: a qualitative study exploring healthcare seeking for sick children in Sierra Leone
Navigating multiple options and social relationships in plural health systems: a qualitative study exploring healthcare seeking for sick children in Sierra Leone
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DOI：
10.1093/heapol/czt016
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发表时间：
2014-05-01
影响因子：
3.2
通讯作者：
George, Asha
中科院分区：
文献类型：
--
作者：
Scott, Kerry;McMahon, Shannon;George, Asha
背景 塞拉利昂已摆脱内战，但仍处于人类发展指数的最低水平。虽然取消使用费等重大医疗改革旨在增加获得服务的机会，但人们对家庭如何利用多元化医疗系统为患病儿童寻求医疗保健却知之甚少。本研究旨在以最近的寻求护理文献为基础，该文献强调从静态的供需范式转向更细致的理解，解释了家庭机构和社会支持在选择方案中的作用。方法在坎比亚、凯拉洪、普杰洪和通科里利这四个地区的设施附近和远离的村庄进行了快速人种学评估。总共在12个村庄完成了36次焦点小组讨论和64次深度访谈。对每个村庄进行结构化观察，详细了解医疗保健来源。结果 当儿童生病时，家庭会在其地理、社会和经济背景下向家庭治疗、草药师、宗教治疗师、毒贩和设施提供者等来源寻求护理。途径各有不同，但居住在距离设施较近的受访者强调设施护理，而居住较远的受访者则采取多管齐下的方法。除了与医疗保健提供的地点和类型相关的因素之外，家庭内部和家庭之间的社交网络和协作也决定了如何最好地照顾生病的孩子，并有助于（或阻碍）调动获得护理所需的资源。丈夫在筹集资金和便利前往设施的交通方面发挥着特别关键的作用。 结论 塞拉利昂的护理人员几十年来一直缺乏足够的医疗保健：他们在制定多种护理策略方面的足智多谋必须得到认可，并将其纳入服务提供改革，从而使医疗保健越来越容易获得。
Background Sierra Leone has emerged from civil war but remains in the lowest tier of the human development index. While significant health reforms, such as the removal of user fees, aim to increase access to services, little is known about how families navigate a plural health system in seeking health care for sick children. This research aims to build on recent care-seeking literature that emphasizes a shift from static supply-and-demand paradigms towards more nuanced understandings, which account for the role of household agency and social support in navigating a landscape of options.Methods A rapid ethnographic assessment was conducted in villages near and far from facilities across four districts: Kambia, Kailahun, Pujehun and Tonkolili. In total, 36 focus group discussions and 64 in-depth interviews were completed in 12 villages. Structured observation in each village detailed sources of health care.Results When a child becomes sick, households work within their geographic, social and financial context to seek care from sources including home treatment, herbalists, religious healers, drug peddlers and facility-based providers. Pathways vary, but respondents living closer to facilities emphasized facility care compared with those living further away, who take multi-pronged approaches. Beyond factors linked to the location and type of healthcare provision, social networks and collaboration within and across families determine how best to care for a sick child and can contribute to (or hinder) the mobilization of resources necessary to access care. Husbands play a particularly critical role in mobilizing funds and facilitating transport to facilities.Conclusion Caregivers in Sierra Leone have endured in the absence of adequate health care for decades: their resourcefulness in devising multiple strategies for care must be recognized and integrated into the service delivery reforms that are making health care increasingly available.