Health Seeking Behavior Post District Health System Reform in Cambodia

柬埔寨的地区卫生系统改革始于1996年。改革的主要特点是建立卫生管理业务区，并实行用户收费。本研究的目的是描述地区卫生体制改革后的就医行为，并比较贫困和富裕人群的就医行为。该研究是在干丹省Leuk Dek区的Prek Dach保健中心覆盖区域进行的。研究对象为育龄家庭主妇（15 ~ 49岁）。采用分层随机抽样的方法，抽取了12%（350户）的家庭。采用结构化问卷和焦点小组讨论（FGD）的入户调查方式收集数据。对符合选拔标准的257名家庭主妇进行了分析。为了确定穷人，使用了住房单位面积和资产所有权评级量表。进行了8次FGD，以调查影响卫生服务选择的因素。257名家庭主妇共有1547名家庭成员。其中，677人在调查前30天内发病。其中，649人采取了就医行动。在第一次行动中，71%的人尝试家庭疗法，50%的人自行用药。公共卫生设施的使用率不到10%。排除那些在第一次治疗中治愈的患者和那些在调查时仍在继续第一次治疗的患者，332人需要采取第二次治疗。其中297人实际上采取了第二次行动。37%的人使用私人服务提供商，33%的人使用自我药物治疗，13%的人使用Prek Dach健康中心。在穷人和富人之间进行比较，穷人使用卫生中心的次数明显多于富人。感知到的疾病严重程度和距离保健中心的距离也与保健中心的利用有关。保健中心对穷人的好处仅限于距离保健中心2公里的范围内。

District Health System Reform in Cambodia started in 1996. The main features of the reform were to establish Operational Districts for health administration, and introduction of user fees. The objectives of this research were to describe health seeking behavior post district health system reform and compare it between the poor and the better off.The study was conducted in Prek Dach Health Center coverage area in the Leuk Dek District, Kandal Province. Subjects were housewives of reproductive age (15 to 49 years old). Twelve percent (350) of the households were selected by stratified random sampling. Data were collected by household survey using structured questionnaire and focus group discussion (FGD). 257 housewives who met selection criteria were analyzed. To identify the poor, housing unit floor area and a rating scale on asset ownership were used. Eight FGD were conducted to investigate factors influencing on choice of health services.257 housewives had a total of 1547 family members. Of them, 677 had an episode of illness within the 30 days prior to the survey. Of them, 649 took health seeking actions. In the first action, 71% tried a home remedy, and 50% did self-medication. Utilization of public health facilities was less than 10%. Excluding those who were cured in the first action and those who were continuing the first action at the time of the survey, 332 needed to take the second action. Of them, 297 actually took the second action. 37% used private service providers, 33% did self-medication, and 13% used the Prek Dach Health Center.Comparing between the poor and the better off, the poor utilized the health center significantly more than the better off. Perceived severity of illness and distance from the health center are also related to the utilization of the health center. The advantage of the health center for the poor is limited within 2km of the distance from the health center.