Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda
Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda
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DOI：
10.1093/heapol/czw180
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发表时间：
2017-09-01
影响因子：
3.2
通讯作者：
Mbonye, Anthony Kabanza
中科院分区：
文献类型：
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作者：
Allen, Elizabeth Palchik;Muhwezi, Wilson Winstons;Mbonye, Anthony Kabanza
虽然有几项研究记录了五岁以下儿童的看护人在乌干达寻求医疗保健时经常遇到的各种障碍，但很少有人试图捕捉看护人自己优先考虑自己寻求服务的障碍的方式。为此，我们要求看护人的焦点小组列出他们在代表五岁以下儿童寻求照顾时面临的五大挑战。采用定性内容分析，我们将响应分为四类：(1)地理访问障碍；(2)设施供应、人员配备和基础设施障碍；(3)设施管理和行政障碍（例如卫生工作者专业精神、缺勤和客户服务）；(4)与财务状况、与男性伴侣的家庭冲突以及对健康相关问题缺乏了解有关的家庭障碍。在所有焦点小组中，看护人员最常提到供应、人员配备和基础设施方面的障碍，而设施管理和行政方面的障碍最少。居住在离公共设施最远的地方（8-10公里）的看护人更常提到地理障碍以及与经济和其他个人情况有关的障碍。住在离卫生设施最近的护理人员提到设施管理和行政障碍的次数是住在较远地方的护理人员的两倍。虽然针对管理障碍至关重要，而且在国家规划者和捐助者中越来越受欢迎，但在这样做的同时，应该认识到，减轻这些障碍可能对地理上难以接触到的看护人产生更大的影响，进而对那些孩子死亡风险增加的人产生更大的影响。考虑到要求在儿童生存规划方面更加公平的呼吁，以及考虑到政策制定者通常可以支配的有限资源，应该权衡对不同环境中照料者之间被认为最重要的障碍的关注。
While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming -and given the limited resource envelopes that policymakers often have at their disposal -attention to the barriers considered most vital among caretakers in different settings should be weighed.