scholarly journals Informal payments in public hospitals in Malawi: the case of Kamuzu Central Hospital

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Annette Mphande-Namangale ◽  
Isabel Kazanga-Chiumia
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Workers ◽  
Public Hospitals ◽  
Poor People ◽  
Central Hospital ◽  
Informal Payments ◽  
Access To Health ◽  
Kamuzu Central Hospital

Abstract Background Informal payments in public health facilities act as a barrier to accessing quality health services, especially for poor people. This research aimed to investigate informal payments for health care services at Kamuzu Central Hospital (KCH), a public referral hospital in Malawi. Results of this study provide evidence on the prevalence and influencing factors of informal payments for health care so that relevant policies and strategies may be developed to address this problem. Methods This study employed a mixed methods research design. The quantitative study had a sample size of 295 patients and guardians. The qualitative study had 7 key informant interviews (with health workers, health managers and policy makers) and 3 focus group discussions (FGDs) with guardians. Each FGD included 10 participants. Thus, in total, the qualitative sample comprised 52 participants. Quantitative data was analyzed using Excel and STATA. Qualitative data was analyzed using a thematic content analysis approach. Results 80% of patients and guardians had knowledge of informal payments. Approximately 47% of respondents admitted making informal payments to access health services, and 87% of informal payments were made at the request of a health worker. Lack of knowledge, fear and desperation among patients and guardians, low salaries of health workers, and lack of effective disciplinary measures, were reported as key factors influencing informal payments. Regression analysis results showed that occupation and gender were the main determinants of informal payments. Conclusions Informal payments exacerbate inequality in access to free public health services. Particularly, poor people have limited access to health services when informal payments are demanded. This practice is unethical and infringes on people’s rights to universal access to health care. There is a need to strengthen the public health care system by formulating deliberate policies that will deter informal payments in Malawi.

scholarly journals Informal Payments in Public Hospitals of Malawi - A Case of Kamuzu Central Hospital

2021 ◽  
Author(s):  
Annette Mphande Namangale ◽  
Isabel Kazanga Chiumia
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Services ◽  
Health Workers ◽  
Public Hospitals ◽  
Poor People ◽  
Central Hospital ◽  
Informal Payments ◽  
Care Services ◽  
Kamuzu Central Hospital

Abstract Background: Informal payments in public health facilities act as a barrier to accessing quality healthcare services especially for the poor people. There is growing evidence that in most low-income countries, most poor people are unable to access quality health care services due to demands for payments for services that should be accessed for free. This research was aimed at investigating informal payments for health care services at Kamuzu Central Hospital, one of the referral public hospitals in Malawi. Results of this study provide evidence on the magnitude and factors influencing informal payments in Malawi so that relevant policies and strategies may be made to address this problem. Methods: The study employed a mixed methods research design. The quantitative study component had a sample size of 295 patients and guardians at Kamuzu Central Hospital (KCH). The qualitative study included 7 in-depth interviews with key informants (health workers) and 3 focus group discussions with guardians. Each FGD had 10 people. Thus, in total the whole qualitative sample constituted 52 participants. Quantitative data was analyzed using Excel and STATA. Qualitative data was analyzed using thematic content analysis approach. Results: 80% of patients and guardians at KCH had knowledge of informal payments. About 47% of the respondents admitted paying informally to access health care services at KCH and 87% of the informal payments were made at the request of a health worker. The study identifies lack of knowledge, fear and desperation by patients and guardians, low salary for health workers and lack of effective disciplinary measures as some of the key factors influencing informal payments in the public health sector in Malawi. Conclusion: Informal payments exacerbate inequality in the access of health care services that should be provided for free. Specifically, poor people have limited access to quality health care services when informal payments are demanded. This practice is unethical and it infringes on people’s rights to universal access to health care. There is need to strengthen the public health care system in Malawi by formulating deliberate policies that will deter informal payments.

scholarly journals Factors contributing to inequality in access to urban health service delivery in low resource setting country

2021 ◽  
Author(s):  
Mohammad Islam ◽  
Muhammad M Kamal
Keyword(s):  
Health Care ◽  
Health Services ◽  
Urban Poor ◽  
Access To Health Care ◽  
Public Hospitals ◽  
Public Health Care ◽  
Equal Access ◽  
Poor People ◽  
Access To Health ◽  
Accessibility Of Health Services

Abstract Background Health is considered as constitutional and fundamental right for general people in Bangladesh. Due to poor socio-economic conditions, income disparities, and socio-cultural barriers, many poor people have limited accessibility in health services and also unable to afford quality health care. This study attempts to examine the factors associated with accessibility and affordability of urban health services. Methods This is an explanatory research which is being carried out using mixed research approach. Primary data was collected using simple random sampling technique from 150 household’s residents in Sylhet City who have experience in receiving services from the urban public health care centers. This study uses a structured interview schedule including both open ended as well as close ended questions. Moreover, descriptive statistics are used for analyzing field data for understanding accessibility of health services. Results This study found that 56% urban poor people have inadequate accessibility of health services as they have different types of financial difficulties including maintaining medical expenditure. The health system prevail discrepancy between mentioned services in citizen charter and availability of services as education and the existence of superstitions significantly impact on access to public health care but religion and age have a little impact in getting health services. Most of the respondents either satisfied (47%) or highly satisfied (29%) with the cordiality of senior consultants, and almost half of the respondents assumed the standard of cabin service is satisfactory (44%) as well as highly satisfactory (2%); however, wealthy and powerful people of the society always get privileges over disadvantaged people paying extra money or social network to get a cabin. Unfortunately, the professionalism of nurses and 4th class employees of public hospitals are not satisfactory. Moreover, there exists a high level of corruption and bureaucratic resistance in public hospitals which hinders equal access of general people to get services. The economic and cultural factors in this research are not highly influential issues for access to health care, but adequate information is one of the challenges for access to health care. Besides, administrative factors in this study have significant influence on the accessibility of health services. Conclusion Equal access to health services from public providers are prime need and right for every resident in Sylhet city. Reform in health system management and service provision are useful for promoting accessibility in health services. Therefore, expansion of health coverage, introduction to health insurance scheme, empowerment of urban poor, and ensuring efficient and accountable health service management in public hospital must be ensured for getting adequate health services.

scholarly journals Can social accountability improve access to free public health care for the poor? Analysis of three Health Equity Fund configurations in Cambodia, 2015–17

2020 ◽  
Vol 35 (6) ◽  
pp. 635-645 ◽  
Author(s):  
Bart Jacobs ◽  
Sam Sam Oeun ◽  
Por Ir ◽  
Susan Rifkin ◽  
Wim Van Damme
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Community Participation ◽  
Health Equity ◽  
Social Accountability ◽  
Poor People ◽  
Access To Health ◽  
Equity Funds ◽  
Free Health Care

Abstract Within the context of universal health coverage, community participation has been identified as instrumental to facilitate access to health services. Social accountability whereby citizens hold providers and policymakers accountable is one popular approach. This article describes one example, that of Community-Managed Health Equity Funds (CMHEFs), as an approach to community engagement in Cambodia to improve poor people’s use of their entitlement to fee-free health care at public health facilities. The objectives of this article are to describe the size of its operations and its ability to enable poor people continued access to health care. Using data collected routinely, we compare the uptake of curative health services by eligible poor people under three configurations of Health Equity Funds (HEFs) during a 24-month period (July 2015–June 2017): Standard HEF that operated without community engagement, Mature CMHEFs established years before the study period and New CMHEFs initiated just before the study period. One year within the study, non-governmental organizations (NGOs) stopped operating the HEF nationwide and only the community-participation aspects of New CMHEF continued receiving technical assistance from an NGO. Using utilization figures for curative services by non-poor people for comparison, following the cessation of HEF management by the NGOs, outpatient consultation figures declined for all three configurations in comparison with the year before but only significantly for Standard HEF. The three HEF configurations experienced a highly statistically significant reduction in monthly inpatient admissions following halting of NGO management of HEFs. This study shows that enhancing access to free health care through social accountability is optimized at health centres through engagement of a wide range of community representatives. Such effect at hospitals was only observed to a limited extent, suggesting the need for more engagement of hospital management authorities in social accountability mechanisms.

scholarly journals Cultural singularities: indigenous elderly access to Public Health Service

2015 ◽  
Vol 49 (4) ◽  
pp. 0589-0595 ◽  
Author(s):  
Ana Carla Borghi ◽  
Angela Maria Alvarez ◽  
Sonia Silva Marcon ◽  
Lígia Carreira
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Public Health Service ◽  
Primary Caregivers ◽  
The Elderly ◽  
Access To Health Services ◽  
Access To Health ◽  
Assistance Service ◽  
Routine Procedures

OBJECTIVEDescribing how Kaingang seniors and their primary caregivers experience access to public health services.METHODA qualitative study guided by ethnography, conducted with 28 elderly and 19 caregivers. Data were collected between November 2010 and February 2013 through interviews and participative observation analyzed by ethnography.RESULTSThe study revealed the benefits and difficulties of the elderly access to health services, the facility to obtain health care resources such as appointments, medications and routine procedures, and the difficulties such as special assistance service problems and delays in the dispatching process between reference services.CONCLUSIONThe importance of knowing and understanding the cultural specificities of the group in order to offer greater opportunities for the elderly access to health services was reinforced.

scholarly journals Factors Affecting Interests of Adolescent Visit in Poly PKPR (Health Care Service) Public Health Gondang Legi Malang District

2020 ◽  
Vol 4 (1) ◽  
pp. 78-85
Author(s):  
Evi Kurniawati ◽  
Nurwijayanti Nurwijayanti ◽  
Agusta Dian Ellina
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Center ◽  
Service Providers ◽  
Health Workers ◽  
Youth Care ◽  
Care Health ◽  
Return Visits

A person's interest in services is related to the ability of these service providers to provide care. Interest in adolescents to take advantage of adolescent health care services is influenced by several factors, including perceptions, peers and the role of health workers in the service at puskesmas. The purpose of this study was to analyze the factors that influence the interest of teenage return visits at the PKPR (Youth Caring Health Services) Gondang Legi Health Center in Malang Regency. The design of this study was an observational quantitative study with a cross sectional approach with the focus of the research directed to be analyzing perceptions, the role of peers and the role of health workers on the interest of teenage return visits at the PKPR (Youth Care Health Services) Gondang Legi Public Health Center Malang Regency with a population of 167 respondents and a sample of 113 respondents taken by accidental sampling technique. The findings found that the majority of respondents had less categories of perception as many as 57 respondents (50.4%). In addition, the majority of respondents had the role of less peer categories of 45 respondents (51.3%). In addition, most respondents had the role of health workers in the good category of 59 respondents (52.2%). While the majority of respondents had a high interest category of 62 respondents (54.9%). The results of the study using the Logistic Regression Test showed that a p-value of 0,000 <0.05 then H1 was accepted so it was concluded that there was simultaneously the influence of perception, the role of peers and the role of health workers on the interest of teenage returnees in the PKPR (Youth Care Health Services) ) Gondang Legi Health Center in Malang Regency. The perspective of the patient regarding the available health services raises their perceptions. All friends will make an impact on individuals. And the provision of special services to adolescents through special treatment tailored to the desires, tastes and needs of adolescents has not been implemented

scholarly journals Relationship of Outpatient Satisfaction With Services Provided by The Officer in General Clinic of Public Health Services Center Kajhu Aceh Besar

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Fahrisal Akbar ◽  
Susanti Susanti
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Workers ◽  
P Value ◽  
Residential Areas ◽  
Public Health Services ◽  
Relationship Of ◽  
The Relationship ◽  
Satisfaction With Services

The existence of community health centers at the moment is still not in line with expectations and desires of the majority of society. Many people who are not satisfied with the services provided by the health workers, it can be seen from many of the patients who still complain. In addition, the attitude of health workers who offend even hurt the feelings of the patient, so that will further lower the level of confidence in the health service. The purpose of this study was to determine the relationship of outpatient satisfaction with services provided by the officer in general clinic of Public Health Services Center Kajhu Aceh Besar.This research is descriptive analytic with quantitative approach and cross-sectional design. The population in this study were all outpatients who visited in the general clinic of public health services Kajhu Aceh Besar, at least, 4 visits totaling 1508 patients. The sample in this study amounted to 98 people and sampling techniques performed by accidental sampling. This study was conducted on February 1 to 29 in 2008, held at the Public Health Services Center Kajhu Aceh Besar. Data collected by interview using a questionnaire to the respondents.The results of this study were obtained, there is no relationship between the variables availability of health facilities with outpatient satisfaction (p-value = 0.179; df = 1; alpha = 0.05). The relationship between the variables of achievement of health care, patient perception, acceptance of health care with outpatient satisfaction (p-value = 0.000; df = 1; alpha = 0.05). From the results of this research, it is recommended that public health officers can improve public health services in the future. In addition, it is expected that the government to immediately establish a public health services center that is located not far from residential areas, so it can be easily affordable for people who need medical care quickly.Keywords: Public Health, Satisfaction, Patient, Health Services

scholarly journals Factors Contributing to Inequality in Access to Urban Health Service Delivery in Low Resource Setting Country Bangladesh 

2021 ◽  
Author(s):  
Mohammad Shafiqul Islam ◽  
Muhammad Mustofa Kamal
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Health System ◽  
Urban Health ◽  
Urban Poor ◽  
Medical Expenditure ◽  
Public Health Care ◽  
Poor People

Abstract Background: Many poor people have limited accessibility in health services and also unable to afford quality health care for poor socio-economic conditions, income disparities, and socio-cultural barriers. This study attempts to examine the factors associated with accessibility and affordability of urban health services.Methods: This research is being carried out using mixed research approach. Primary data was collected using simple random sampling technique from 150 household’s residents in Sylhet City who have experience in receiving services from the urban public health care centers. This study uses a structured interview schedule both open ended as well as close ended questions. Moreover, descriptive statistics are used for analyzing field data. Results: This study found that 56% urban poor people have inadequate accessibility of health services as they have different types of financial difficulties including maintaining medical expenditure. The health system prevail discrepancy between mentioned services in citizen charter and availability of services as education and the existence of superstitions significantly impact on access to public health care but religion and age have a little impact in getting health services. Most of the respondents either satisfied (47%) or highly satisfied (29%) with the cordiality of senior consultants, and almost half of the respondents assumed the standard of cabin service is satisfactory (44%) as well as highly satisfactory (2%); however, wealthy and powerful people of the society always get privileges over disadvantaged people paying extra money or social network to get a cabin. Unfortunately, the professionalism of nurses and 4th class employees of public hospitals are not satisfactory. Moreover, the public health system exist a high level corruption and bureaucratic barrier that affect equal health service accessibility. Furthermore, adequate information is a more challenging factor than economic and cultural factors in access to adequate health care.Conclusion: Reform in health system management and service provision are useful for promoting accessibility in health services. Therefore, expansion of health coverage, introduction to health insurance scheme, empowerment of urban poor, and ensuring efficient and accountable health service management in public hospital must be ensured for getting adequate health services.

scholarly journals Too long to wait: South Asian migrants’ experiences of accessing health care in Australia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manju Adhikari ◽  
Sabitra Kaphle ◽  
Yamuna Dhakal ◽  
Sabina Duwadi ◽  
Rajan Subedi ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Chronic Diseases ◽  
South Asian ◽  
Access To Health Care ◽  
Online Survey ◽  
Public Health Care ◽  
Factors Influencing ◽  
Access To Health

Abstract Background Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia. Methods Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically. Results South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings. Conclusions Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.

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