‘Others Will Even Call us Terminators’: Barriers and Facilitators to Provision of Comprehensive Abortion Care (Cac) in Zambia – A Qualitative Study

Abstract Background:It is estimated that one in every five pregnancies globally ends up as abortion, with about 40% being unsafe. Abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC), which aims to provide high quality, safe and affordable services to women, unsafe abortions rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia.Materials and methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August, 2021 in nine selected public health facilities of Zambia. A total of 17 interviews were conducted with participants purposively sampled. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed a number of barriers and facilitators most of which are health system related. The health system related barriers included inadequate CAC providers, healthcare provider perception that provision of CAC was optional, lack of CAC dedicated space and privacy, frequent shortages of medical supplies and lack of incentives, while individual related barriers included stigma surrounding CAC provision, religious and moral dilemmas. Facilitators to CAC provision included having providers trained and mentored in CAC, availability of a liberal legal framework, accessible services, task shifting and external financial support. Conclusions: The findings of this study on the several barriers of CAC reinforces the idea that despite having appropriate legal provisions to CAC provision in Zambia, challenges in the implementation of the law and related service provision continue to persist. The identified barrriers suggests to consider incorporating CAC services into the pre-service training to ensure more trained and skilled providers are available in the public facilities.

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Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

10.1101/19013920 ◽

2019 ◽

Author(s):

Martin Muddu ◽

Andrew K. Tusubira ◽

Brenda Nakirya ◽

Rita Nalwoga ◽

Fred C. Semitala ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Health Care Providers ◽

Implementation Research ◽

Barriers And Facilitators ◽

Health System Strengthening ◽

Prior Work ◽

Care Providers ◽

Inner Setting ◽

Hiv Integration

AbstractBackgroundPersons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to, and facilitators of, integrating HTN screening and treatment into HIV clinics in Eastern Uganda.MethodsWe conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used both deductive (CFIR model-driven) and inductive (open coding) methods to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration.ResultsOf the 39 CFIR constructs assessed, 17 were relevant to either barriers or facilitators to HTN/HIV integration. Six constructs strongly distinguished performance and were barriers, three of which were in the Inner setting (Organizational Incentives & Rewards, Available Resources, Access to Knowledge & Information); two in Characteristics of individuals (Knowledge & Beliefs about the Intervention and Self-efficacy) and one in Intervention characteristics (Design Quality & Packaging). Four additional constructs were weakly distinguishing and negatively influenced HTN/HIV integration. There were four facilitators for HTN/HIV integration related to the intervention (Relative advantage, Adaptability, Complexity and Compatibility). The remaining four constructs negatively influenced HTN/HIV integration but were non-distinguishing.ConclusionUsing the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration in the Inner setting, Outer setting, Characteristics of individuals and implementation Process, HTN/HIV integration is of interest to patients, health care providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on the facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.Contribution to the literatureWe used the widely used and validated CFIR to assess the HIV program for HTN/HIV integration.To our knowledge, this is the first study to explore barriers and facilitators to integrating hypertension screening and treatment into HIV clinics using the CFIR.The barriers and facilitators identified are a basis for designing contextualized implementation interventions for HTN/HIV integration in Uganda and other LMIC using a health system strengthening approach.

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Abortion care-seeking and reproductive rights violation in health facilities: evidence from six states of India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215108 ◽

2021 ◽

Vol 11 (1) ◽

pp. 221

Author(s):

Manas Ranjan Pradhan ◽

Chander Shekhar ◽

Manoj Alagarajan ◽

Harihar Sahoo

Keyword(s):

Health Care ◽

Health Care Providers ◽

Rural Areas ◽

Reproductive Rights ◽

Health Centre ◽

Health Facilities ◽

Bivariate Analysis ◽

Care Providers ◽

Safe Abortion ◽

Abortion Care

Background: Unsafe abortion continues to draw the researcher's attention due to its close association with maternal morbidity and mortality. Empirical evidence on the role of health facilities in providing safe abortion care addressing the reproductive rights of Indian women is limited.Methods: Using data from the 2015 ‘unintended pregnancy and abortion in India’ study, the present paper aimed to understand the violation of the reproductive rights of abortion care seekers in health facilities (n=4001) in six states of India. The health facilities were sampled using a stratified random sampling strategy. Univariate and bivariate analysis was carried out using SPSS (V 25) on cleaned and weighted data.Results: A sizeable percentage of public and private health facilities across states found seeking the consent of the husband or family members before abortion provision, compel women to adopt contraception and turn away abortion seekers, commonly citing non-medical reasons. The provision of post-abortion complications services is usually not 24/7, even at the primary health centre level, hindering access to an urgent health care need.Conclusions: There is a need to improve access to facility-based abortion services, especially in underserved rural areas, by ensuring that all public-sector facilities have adequate equipment and supplies, including MMA drugs and trained providers. Sensitization of health care providers about the importance of ethical issues and women’s reproductive rights is urgently required to ensure safe, legal, and accessible abortion care.

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A qualitative study on health care providers’ experiences of providing comprehensive abortion care in Cox’s Bazar, Bangladesh

Conflict and Health ◽

10.1186/s13031-021-00338-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Maria Persson ◽

Elin C. Larsson ◽

Noor Pappu Islam ◽

Kristina Gemzell-Danielsson ◽

Marie Klingberg-Allvin

Keyword(s):

Health Care ◽

Health Care Providers ◽

Service Provision ◽

Care Providers ◽

Personal Beliefs ◽

Menstrual Regulation ◽

Humanitarian Settings ◽

Abortion Care ◽

Regulation Policy ◽

Comprehensive Abortion Care

Abstract Background Humanitarian settings are characterised by limited access to comprehensive abortion care. At the same time, humanitarian settings can increase the vulnerability of women and girls to unintended pregnancies and unsafe abortions. Humanitarian actors and health care providers can play important roles in ensuring the availability and accessibility of abortion-related care. This study explores health care providers’ perceptions and experiences of providing comprehensive abortion care in a humanitarian setting in Cox’s Bazar, Bangladesh and identifies barriers and facilitators in service provision. Method In-depth interviews (n = 24) were conducted with health care providers (n = 19) providing comprehensive abortion care to Rohingya refugee women and with key informants (n = 5), who were employed by an organisation involved in the humanitarian response. Data were analysed using an inductive content analysis approach. Results The national menstrual regulation policy provided a favourable legal environment and facilitated the provision of comprehensive abortion care, while the Mexico City policy created organisational barriers since it made organisations unable or unwilling to provide the full comprehensive abortion care package. Supplies were available, but a lack of space created a barrier to service provision. Although training from organisations had made the health care providers confident and competent and had facilitated the provision of services, their knowledge of the national abortion law and menstrual regulation policy was limited and created a barrier to comprehensive abortion services. Even though the health care providers were willing to provide comprehensive abortion care and had acquired skills and applied strategies to communicate with and provide care to Rohingya women, their personal beliefs and their perceptions of Rohingya women influenced their provision of care. Conclusion The availability and accessibility of comprehensive abortion care was limited by unfavourable abortion policies, a lack of privacy, a lack of knowledge of abortion laws and policies, health care providers’ personal beliefs and a lack of cultural safety. To ensure the accessibility and availability of quality services, a comprehensive approach to sexual and reproductive health and rights is needed. Organisations must ensure that health care providers have knowledge of abortion policies and the ability to provide quality care that is woman-centred and non-judgmental.

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The legal framework applicable to insecurity and violence affecting the delivery of health care in armed conflicts and other emergencies

International Review of the Red Cross ◽

10.1017/s1816383114000137 ◽

2013 ◽

Vol 95 (889) ◽

pp. 83-127 ◽

Cited By ~ 5

Author(s):

Alexander Breitegger

Keyword(s):

Health Care ◽

Medical Ethics ◽

Health Care Providers ◽

Delivery Of Health Care ◽

Access To Health Care ◽

Legal Framework ◽

Armed Conflicts ◽

Health Care Personnel ◽

International Human Rights Law ◽

Care Providers

AbstractEnsuring respect for, and protection of, the wounded and sick and delivery of health care to them were at the origin of the Red Cross and Red Crescent Movement, as well as the development of international humanitarian law (IHL). In today's armed conflicts and other emergencies, the problem is not the lack of existing international rules but the implementation of relevant IHL and international human rights law (IHRL) which form a complementary framework governing this issue. Against the backdrop of the different manifestations of violence observed by the ICRC in the field and expert consultations held in the framework of the Health Care in Danger Project, this article identifies commonalities between the two legal regimes, including with respect to obligations to provide and facilitate impartial health care; prohibitions of attacks against wounded and sick and health-care providers; prohibitions to arbitrarily obstruct access to health care; prohibitions to harass health-care personnel, in violation of medical ethics; or positive obligations to ensure essential medical supplies and health-care infrastructure and protect health-care providers against violent interferences by others. The article concludes by indicating certain areas where implementation of existing IHL and IHRL is needed, including in domestic normative frameworks, military doctrine and practice, as well as training of health-care personnel on these international legal frameworks and medical ethics.

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Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.155 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 155-155

Author(s):

Cleo A. Samuel ◽

Kea Turner ◽

Heidi AS Donovan ◽

G J. Van Londen

Keyword(s):

Health Care ◽

Endocrine Therapy ◽

Health Care Providers ◽

Symptom Management ◽

Adjuvant Endocrine Therapy ◽

Barriers And Facilitators ◽

System Level ◽

Care Providers ◽

Provider Perspectives ◽

Related Symptom

155 Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) typically involves a multidisciplinary team of health care providers; yet few studies have examined provider perspectives on AET-related SM. The purpose of this study was to examine provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM and its barriers and facilitators as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described patient-, provider-, and system- level facilitators and barriers to AET-related SM. At the patient-level, facilitators included social support and provider communication about symptoms while cancer-related distress, misinformation and misinterpretation of online information were identified as barriers. Provider-level facilitators included strong relationships with other providers and ongoing communication with patients; however, lack of time, insufficient resources, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Finally, at the system-level, electronic health records were described as both a facilitator and barrier to SM. Moreover, poor care coordination among different providers and lack of clear guidelines on which provider “owns” AET-related SM emerged as key system-level barriers. Conclusions: Findings suggest that efforts to improve AET-related SM should span multiple levels, in order to address patient-, provider-, and system-level barriers to SM. Recommendations include increased education for patients, greater access to clinical decision support tools for providers, and improved coordination of survivorship resources within hospitals.

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Management of services in total quality management implemented and non-implemented health facilities

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v6i4.51235 ◽

2021 ◽

Vol 6 (4) ◽

pp. 689-696

Author(s):

Muhsina Begum ◽

Ashees Kumar Saha ◽

Sheuly Begum ◽

Nasima Akhter ◽

Pritikona Borua ◽

...

Keyword(s):

Health Care ◽

Quality Management ◽

Total Quality Management ◽

Health Care Providers ◽

Service Providers ◽

Health Facilities ◽

Working Environment ◽

Care Providers ◽

Total Quality ◽

Medical College

5S-CQI-TQM is a management technique that is aimed at bringing satisfaction of staff as well as the patients through improvement of working environment. A cross-sectional comparative study was carried out among 226 respondents who were selected purposively from the selected study place from 1st January to 31st December 2017. Among 226 respondents, 113 were taken from Dhaka Medical College and another 113 were taken from Mugdha Medical College. Among 113 respondents, 56 respondents were health care providers and 57 respondents were health care receivers. The purpose of this study to compare the management of services in Total Quality Management implemented (Dhaka Medical College and Hospital) and non-implemented (Mugdha Medical College and Hospital) health facilities. A Semi-structured interviewer administered questionnaire and an observational check list were developed to collect the data. Separate questionnaire was used for health care providers and health care receivers. The statistical analysis was conducted using SPSS (statistical package for social science) version 20 statistical software. Significant statistical differences were found between TQM implemented and TQM non-implemented hospital regarding workload (p=0.043), hospital authority always seriously consider staff’s suggestions for the improvement of quality of service (p<0.001), employees always respect to each other in the hospital (p<0.001) and 35 (62.5%) service providers expressed satisfactory opinion regarding management of the hospital. Asian J. Med. Biol. Res. December 2020, 6(4): 689-696

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Assessment of the Implementation of Tuberculosis and Diabetes Care in health systems: A Situational Analysis in Western Nigeria for consideration

10.21203/rs.2.12294/v1 ◽

2019 ◽

Author(s):

ASAGA MAC PETER ◽

JUDE OSAGIE Aighobahi.

Keyword(s):

Health Care ◽

Health Systems ◽

Health Care Providers ◽

Health Facilities ◽

Situational Analysis ◽

Care Providers ◽

Cross Sectional ◽

Attitudes And Practices ◽

Low Middle Income Countries ◽

Diabetes Patients

Abstract Background: Tuberculosis (TB) coexists with other non-communicable diseases (NCDs), including Diabetes Mellitus (DM). Smoking increases the risk of TB as well as DM. Health systems are poorly prepared in many low middle income countries (LMICs) and are currently facing the "triple burden of smoking, TB, and DM" that drives these countries into the vicious cycle of poverty. Methods: A cross-sectional study method was carried out to assess the proportion of TB care centers that included integration measures for diabetic care as well as those providing DM care that included integration measures for TB. A list of 49 health care centers in Lagos offering TB care and managing Diabetes patients were recruited. A focus Group Discussion(FGD) and Individual interviews were conducted to investigate health care providers ' knowledge, attitudes and practices and the barriers encountered in the process of integrating TB and DM care. Results: Out of the 49 health care centres recruited in this study, 6% of health care units are aware of a surveillance to screen for diabetes in tuberculosis patients, while 2% of health facilities confirmed awareness of a surveillance to screen for tuberculosis in diabetes patients. 91% of health centres either verified the lack of or no understanding of monitoring of both diseases. The percentage of health facilities that have existing guideline on TB and DM screening was evaluated, it was perceived that 8% of health facilities had implemented a guideline to screen for DM in TB patients, while 4% of these Care Centres have implemented a guideline for diabetes patients to be screened for TB. Conclusion TB/DM integrative screening, treatment and management could be better attained if both co-morbidities integration program is initiated in the healthcare centres and policies of western states and Nigeria as a whole.

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Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation

F1000Research ◽

10.12688/f1000research.17208.2 ◽

2020 ◽

Vol 8 ◽

pp. 229

Author(s):

Anne Pfitzer ◽

Christina Maly ◽

Hannah Tappis ◽

Mark Kabue ◽

Devon Mackenzie ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Health Care Providers ◽

Mixed Method ◽

Physical Space ◽

Health Facilities ◽

Child Health Services ◽

Care Providers ◽

Cross Sectional ◽

And Child Health

Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

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Reproductive awareness and recognition of unintended pregnancy: young women, key informants and health care providers perspectives in South Africa

Reproductive Health ◽

10.1186/s12978-021-01262-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Oluwaseyi Dolapo Somefun ◽

Jane Harries ◽

Deborah Constant

Keyword(s):

South Africa ◽

Health Care ◽

Unintended Pregnancy ◽

Health Care Providers ◽

Signs And Symptoms ◽

Second Trimester ◽

Care Providers ◽

Policy Makers ◽

Abortion Care ◽

Pregnancy Status

Abstract Background South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of pregnancy. Methods We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis. Results Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible. Conclusion Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.

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