scholarly journals Barriers to the uptake of community-based curative child health services in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Birkety Mengistu ◽  
Meron Paulos ◽  
Nesibu Agonafir ◽  
Agazi Ameha ◽  
Hailemariam Legesse ◽  
...  
Keyword(s):  
Health Services ◽  
Traditional Healers ◽  
Child Health Services ◽  
Service Availability ◽  
Supply Side ◽  
Health Post ◽  
Health Extension Workers ◽  
Community Based ◽  
Demand Creation ◽  
Illness Causation

Abstract Background Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project. Methods Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions. Results Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier. Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery. Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services. Conclusion This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.

scholarly journals Health Extension Workers Involvement in the Utilization of Focused Antenatal Care Service in Rural Sidama Zone, Southern Ethiopia: A Cross-Sectional Study

2019 ◽  
Vol 6 ◽  
pp. 233339281983513 ◽  
Author(s):  
Achamyelesh Gebretsadik ◽  
Million Teshome ◽  
Mekdes Mekonnen ◽  
Akalewold Alemayehu ◽  
Yusuf Haji
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Multivariate Logistic Regression Analysis ◽  
Maternal Health Services ◽  
Child Health Services ◽  
Outcome Variable ◽  
Health Extension Workers ◽  
Cross Sectional ◽  
Focused Antenatal Care

Background: Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC). Methods: A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software. Results: The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244 (46.47%; 95% CI: 43.5-47.7%) of mothers. The FANC utilization was less likely among those who were illiterate (adjusted odds ratio [AOR]: .32; 95% CI: .18-.57) and those who attended first cycle (AOR: .41; 95% CI: .23-.74), those who attended secondary cycle (AOR: .47; 95% CI: .27-.82), primipara (AOR: 0.53; 95% CI: .35-.83), and those who gave birth at home (AOR: .66; 95% CI: .51-.84). Mothers who had knowledge of pregnancy danger signs (AOR: 1.42; 95% CI: 1.2-1.7) and exposure to mass media (AOR: 1.35; 95% CI: 1.1-1.66) were more likely to utilize FANC. Conclusions: FANC utilization in this study was low compared to other studies. The HEWs had a major contribution to the services. However, it is low when compared to the plan set by the state ministry of health. The existing health extension program could be strengthened by increasing the number of HEWs. Empowering rural mothers through continuous education program to enhance the utilization of maternal health services.

The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi

2019 ◽  
Vol 23 (11) ◽  
pp. 1556-1563
Author(s):  
Anne Matthews ◽  
Aisling Walsh ◽  
Ruairi Brugha ◽  
Lucinda Manda-Taylor ◽  
Daniel Mwale ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Child Health Services ◽  
Supply Side ◽  
Demand And Supply ◽  
Newborn And Child Health ◽  
And Child Health

scholarly journals Trust of community health workers influences the acceptance of community-based maternal and child health services

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Merridy Grant ◽  
Aurene Wilford ◽  
Lyn Haskins ◽  
Sifiso Phakathi ◽  
Ntokozo Mntambo ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Health System ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Community Members ◽  
Community Based ◽  
Complex Relationships ◽  
And Child Health

Background: Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings.Aim: To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves.Setting: Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa.Methods: A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing.Results: Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community.Conclusion: Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

scholarly journals FACILITY ASSESSMENT FOR MATERNAL AND CHILD HEALTH SERVICES IN BANGLADESH USING SERVICE AVAILABILITY AND READINESS ASSESSMENT (SARA) TOOL: A CROSS-SECTIONAL PILOT STUDY

2017 ◽  
Vol 3 (3) ◽  
pp. 77-88
Author(s):  
Afzal Aftab ◽  
Mehedi Hasan ◽  
Rahmatul Bari ◽  
Mohammad Didar Hossain ◽  
Mehadi Hasan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Health Facilities ◽  
Child Health Services ◽  
Service Availability ◽  
Readiness Assessment ◽  
Cross Sectional ◽  
And Child Health

Background: To initiate journey towards the Universal Health Coverage (UHC) it is essential to assess the health facilities. Unfortunately, no health facility assessment has been conducted in Bangladesh so far using “Service Availability and Readiness Assessment (SARA)” tool. Therefore, we aimed to conduct a pilot study to assess health facilities for maternal and child health services using SARA tool so that we can scale-up this assessment throughout the country later.Aim: We aimed to assess the health facilities for maternal and child health services in Tangail, Bangladesh using service availability and readiness assessment (SARA) tool.Methods: A cross-sectional pilot study was conducted in Bashail and Shokhipur Upazilla of Tangail district. A sample of 14 health facilities was assessed purposefully for data collection using a modified version of the SARA tool. Data was collected from November 01 to November 15, 2013, using paper-based questionnaire. Finally, following data collection, data were documented into Microsoft Excel by data collectors. Data were analyzed using Microsoft Excel, version 2010.Results: General service readiness has been segregated into five domains and their readiness scores were basic amenities (53.06%), basic equipment (83.33%), standard precautions for infection prevention (55.56%), and basic equipment (58.93%) for included health facilities. Similarly, specific service readiness includes family planning (48.15%), child immunization (67.71%), preventive and curative care (71.43%), and basic surgery (93.33%).Conclusion: Since we are moving towards UHC, it is essential to know the current scenario of health facilities. This pilot study reveals the strength and weakness of the health facilities in providing the maternal and child health services. These findings will help us to resolve all the identified gaps through proper planning and action.

scholarly journals Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India

2020 ◽  
Author(s):  
Shantanu Sharma ◽  
Devika Mehra ◽  
Faiyaz Akhtar ◽  
Sunil Mehra
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Qualitative Interviews ◽  
Child Health Services ◽  
Access To Health Services ◽  
Community Based ◽  
Access To Health ◽  
Marginalized Women ◽  
And Child Health

Abstract Background Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions (CBI) based on building women’s groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approaches in improving their access to health services. The present endeavour evaluates a community-based intervention aimed at improving marginalized women’s awareness and utilization of maternal, and child health services, and access to livelihood and savings using the peer-led approach from two districts of India. Methods We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community levels. The intervention was implemented in two marginalized districts of Uttar Pradesh, namely Banda and Kaushambi. Two development blocks in each of the two districts were selected randomly, and twenty-four villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, pre- and post-research design, using a mixed-method approach. Data were collected at three points in time, including a rapid assessment (quantitative and qualitative interviews) at baseline, qualitative interviews at the end line and tracking data of the intervention population (n=37,324) through an online management information system. Results Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for the livelihood scheme, and 94% and 80% of them had worked in these two places, respectively under the scheme. Women during group discussions informed that their awareness about MCH increased post-intervention. The money earned after getting work under the livelihood scheme or from daily savings was deposited in the bank account by the women. These savings helped the women investing money at times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. Conclusion Peer-led model of intervention can be explored to improve the combined health and economic outcomes of marginalized women.

scholarly journals Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

2019 ◽  
Vol 4 (4) ◽  
pp. e001529 ◽  
Author(s):  
Sarah L Dalglish ◽  
Sarah Straubinger ◽  
Justine A Kavle ◽  
Lacey Gibson ◽  
Evariste Mbombeshayi ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Community Health ◽  
Democratic Republic ◽  
Health Workers ◽  
Traditional Healers ◽  
Child Health Services ◽  
Health Providers ◽  
Community Members ◽  
Republic Of The Congo

Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families’ and communities’ health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called ‘white man’s diseases.’ Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families’ first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for ‘modern’ diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.

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