When free healthcare is not free. Corruption and mistrust in Sierra Leone's primary healthcare system immediately prior to the Ebola outbreak
When free healthcare is not free. Corruption and mistrust in Sierra Leone's primary healthcare system immediately prior to the Ebola outbreak
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DOI：
10.1093/inthealth/ihv024
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发表时间：
2015-11-01
影响因子：
2.5
通讯作者：
Lodge, Tom
中科院分区：
文献类型：
--
作者：
Pieterse, Pieternella;Lodge, Tom
简介：塞拉利昂是最近受埃博拉影响的三个国家之一。在围绕最初未能遏制疫情的情况进行的辩论中，经常使用“信任”一词：2014年12月，世界卫生组织总干事陈冯富珍使用了“对政府缺乏信任”； 《柳叶刀》的主编写道，埃博拉病毒如何暴露了“……社区与其政府之间信任的崩溃”。本文探讨了埃博拉疫情爆发之前塞拉利昂对公共医疗保健提供者缺乏信任的情况，这显然与初级医疗机构普遍存在的小规模腐败有关。它比较了针对塞拉利昂初级卫生部门的四种非政府组织支持的问责干预措施。方法：基于对卫生工作者的访谈以及与初级卫生保健用户的焦点小组讨论，在凯拉洪、科诺和通科利利地区进行了实地研究。结果：实地研究表明，在大多数诊所，有权享受免费护理的妇女和儿童通常为卫生服务付费。结论：塞拉利昂卫生部门各个层面普遍缺乏问责制。小腐败盛行。人手不足导致免费护理收费，以便向诊所的“志愿者”支付费用，这些志愿者充当疫苗接种员、卫生工作者和助产士。研究发现，问责干预措施对卫生工作者的（不当）行为几乎没有影响。
Introduction: Sierra Leone is one of three countries recently affected by Ebola. In debates surrounding the circumstances that contributed to the initial failure to contain the outbreak, the word 'trust' is often used: In December 2014, WHO director Margret Chan used 'lack of trust in governments'; The Lancet's Editor-in-Chief, wrote how Ebola has exposed the '...breakdown of trust between communities and their governments.' This article explores the lack of trust in public healthcare providers in Sierra Leone, predating the Ebola outbreak, apparently linked to widespread petty corruption in primary healthcare facilities. It compares four NGO-supported accountability interventions targeting Sierra Leone's primary health sector.Methods: Field research was conducted in Kailahun, Kono and Tonkolili Districts, based on interviews with health workers and focus group discussions with primary healthcare users.Results: Field research showed that in most clinics, women and children entitled to free care routinely paid for health services.Conclusions: A lack of accountability in Sierra Leone's health sector appears pervasive at all levels. Petty corruption is rife. Understaffing leads to charging for free care in order to pay clinic-based 'volunteers' who function as vaccinators, health workers and birth attendants. Accountability interventions were found to have little impact on healthworker (mis)behaviour.