Ghana's community-based primary health care: Why women and children are 'disadvantaged' by its implementation
Ghana's community-based primary health care: Why women and children are 'disadvantaged' by its implementation
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DOI：
10.1016/j.socscimed.2018.02.001
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发表时间：
2018-03-01
影响因子：
5.4
通讯作者：
Esena, Reuben K.
中科院分区：
文献类型：
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作者：
Atinga, Roger A.;Agyepong, Irene Akua;Esena, Reuben K.
尽管初级保健方案的实施有限，但对中低收入环境中的妇女和儿童在获得适当保健方面仍然处于不利地位的原因进行了政策分析。借鉴街头一级的官僚理论，我们探讨了如何以及为什么前线供应商（FLP）自己的行动，并在与卫生系统因素的相互作用形状加纳的以社区为基础的初级保健实施的妇女和儿童获得和使用卫生服务的不利条件。这是一项在上西部地区农村和城市地区的4个社区进行的定性研究。数据收集自8个与社区知情人的焦点小组讨论、73个与客户的深入访谈、13个与地区卫生管理人员和FLP的深入访谈以及观察。借助Nvivo 11软件，对数据进行了记录、转录和编码，并对主题进行了演绎和归纳。调查结果表明，除了家庭暴力受害者经常迟到和缺勤影响到寻求儿童照料外，他们在确定哪些儿童值得照料方面行使酌处权产生了连锁反应：家庭在寻求儿童替代照料方面遇到了经济困难，并通过在非传统场所提供照料来控制症状来避免这种情况。FLP的不良行为是由地区卫生系统中薄弱的执行结构驱动的。基本的产科设施，如产房、输液架、分娩床、拘留和触诊床都缺乏，这促使斐济妇女解放组织采用拼凑起来的临时分娩方法进行分娩，以鼓励无人协助的家庭分娩。人们认为服务条件较差，削弱了FLP对优质妇幼保健服务的承诺。研究结果表明，有必要制定战略，以诱导行为改变FLP，加强地区行政结构，并改善供应链和物流系统，以解决CHPS孕产妇和儿童保健服务的差距。
Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics system to address gaps in CHPS maternal and child care delivery.