Background
The study setting and approach
Participant selection
Interviews
Data analysis
Trustworthiness
Findings
Characteristics of the study participants
KII Code | Age | Educational status | Marital status | Religion | Responsibility related to Child Health |
---|---|---|---|---|---|
KII-01 | 45 | MPH | Marrid | Protestant | Expertise |
KII-02 | 30 | MPH | Single | Orthodox | Expertise |
KII-03 | 46 | MPH | Married | Protestant | Expertise |
KII-04 | 44 | MPH | Married | Protestant | Expertise |
KII-05 | 39 | MPH | Married | Orthodox | Expertise |
KII-06 | 40 | MPH | Married | Protestant | Expertize |
KII-07 | 45 | MPH | Married | Proestant | Expertise |
KII-08 | 55 | MPH | Married | Protestant | Expertise |
KII-09 | 39 | Level 4 | Marred | Muslim | HEW |
KII-10 | 35 | Level4 | Marred | Muslim | HEW |
KII-11 | 48 | Level 4 | Married | Muslim | HEW |
KII-12 | 30 | Diploma | Married | Muslim | Head of Health Center |
KII-13 | 28 | BSc | Married | Orthodox | Expertise |
KII-14 | 41 | Diploma | Married | Muslim | Head of Health Center |
KII-15 | 28 | Level 4 | Married | Muslim | Head of health center |
KII-16 | 28 | Level 3 | Divorced | Muslim | HEW |
KII-17 | 34 | Level 4 | Married | Muslim | HEW |
KII-18 | 32 | BSc | Married | Orthodox | District health office head |
KII-19 | 40 | BSc | Married | Orthodox | Expertise |
KII-20 | 29 | BSc | Married | Protestant | HEW |
FGD Participant | |||
---|---|---|---|
FGD No | Category | No of Participants | Site |
FGD-1 | Female FGD | 10 | Ogolcho rural |
FGD-2 | Female FGD | 10 | Haraxa rural |
FGD-3 | Female FGD | 10 | Gulele rural |
FGD-4 | Male FGD | 12 | Ogolcho town |
FGD-5 | Male FGD | 8 | Haraxa town |
FGD-6 | Male FGD | 8 | Ula arba |
Barriers to equitable healthcare services for under-five children
Six major themes emerged from the findings
Themes | Sub-themes/ Category | Codes |
---|---|---|
Lack of awareness of the service | -Lack of information about availability of services -Low awareness -Lack of knowledge about benefits of child healthcare | - Lack of adequate information (5) -Lack of or limited knowledge of benefit of child healthcare (4) - Limited health literacy (7) |
Socioeconomic barriers | Low household income -Low educational attainment | -Financial barriers of families (6) - Cost of care and transportation cost (9) -Indirect costs health care fee (4) -Women’s education (3) -Paternal education (5) |
Geographical barriers | -Distance of health facility from home - Lack of roads -Poor roads - Transportation problems - | -Lack of proximity of the health services from home (16) -Unavailability of transportation system (18) -Barriers in reaching health facility (6) - Transportation related barriers (12) -Lack of ambulance services (150 -Weather conditions and poor roads (3) |
Health system barriers | -Unavailability of the services -Inaccessibility of the heath facility -Unaffordability of health services cost - Absence of compassionate and respectful care among health professionals - Unavailability of drugs and medical supplies | -Inadequate material, drugs, laboratory supplies (8) -Distance from home (12) - Payment for ambulance (4) -disrespectful and abusive care by HCWs (4) -Lack of experienced health providers (2) - Language barrier (2) -Low quality of care (2) -Lack of transportation (12) -Lack of planning for marginalized peoples (7) - Lack of giving priority for poor people (5) |
Cultural and behavioral barriers | - Traditions and beliefs -Taboos related to neonatal death - | - Cultural beliefs and traditions prohibit the neonate from accessing health facility (8) - Traditions and beliefs (7) -Lack of women’s autonomy (5) |
Politics, conflict and security issue | -Insecurity due to conflict - Political instability | People are killed (22) Closed roads (19) -No transport (20) Health facilities are not functional or destroyed (14) -Health professionals feel insecure or are killed (18) |
Lack of awareness about benefits of the services
“…. Children who visited our health center with malnutrition were from remote and far to reach areas and were brought to our health facility only after these cases were seriously complicated. So there is great variation among urban and rural, rich and poor, literate and illiterate communities in child health care service utilization in our district.” Male , KII, age 34years
“Yes, if I had been aware of the benefit of immunization and informed that they were given free of charge, I would have used these services for my sick child from health posts, not from traditional healers” Female FGD discussant, age 35 years, Seeking care from traditional healer
“Most of the women’s and care givers did not know about the availability of treatment at the health post, especially for diarrhea and pneumonia. Those women’s who live near a health facility, are educated and young have more awareness about childhood illnesses and seek care from health posts than uneducated mothers; this may result in inequitable utilization of health services by illiterate care givers” KII, Female 35 years
“We improve the awareness of our community on child healthcare utilization through women’s development army and cultural leaders, we trained these women about early recognition of maternal and child health danger sign. we provide them local COC for them. By now in our district, women’s development armies have equivalent knowledge with HEW and, we used them to teach the community”. Male, Key informant, age 42 year.
Socioeconomic barriers
“Yes, nowadays, the cost of drugs and treatment for childhood illness is increasing, when I used to get treatment for my sick child from a health center or health post the health professional referred me to a private clinic to be seen or diagnosed by a highly expensive machine; I am unable to afford for this machine. Moreover there were no drugs at the health post and the health center. They told us to purchase them from private clinics. So, how can the poor people get treatment from Governmental health facility?” Female FGD discussant age, 34 years, with low income.
“Yes, getting treatment in this health facility is good but sometimes you go here and there to get examined and prescribed for drugs and you need money for those drugs. If you don’t have money, then you remain with the illness” Female FGD discussant, age 29 years.
Geographical barriers
“…the primary issue facing this district is the lack of transportation and the distance between the residential area and the medical facilities. The caregivers were unable to get transportation service easily. In some areas the distance between health facilities and residential areas of the community is too far, besides there is no road to get access to health facility. We need more vehicles at health center level; moreover, the transportation issue cannot be solved unless quality roads will be constructed for the community.”Male, key-informant interview, age 40 years.
“ Yaa, we move more than 30 km on foot to access health facilities, especially health centers, there is no road for cars., we carry our sick child on our backs to get treatment from this health facility” FGD, Male, age 44 years.
“…even though roads were constructed, there is no reliable transportation system in our area. Ambulance service is not available in our area, no mobile network to call to ambulance service. Moreover, if we were hardly access the ambulance, we are requested to pay 1000 Birr for fuel. Therefore, the Government and concerned body has to understand and solve our situation related to distance and transportation problem.” Male, FGD discussant, Age 49 year.
Healthcare system barriers
“Even though, the health posts are expected to give maternal and child health services for the rural community free of charge, how the poor and the rural community get these services, the health posts were closed during working hours, most of the time the HEW workers are in another duty, they were assigned to collect taxes and insurance from the community, so the richest household will get these services from private health institution but the poor and the rural community is in problem in accessing these services” Key-informant interview, Male, 45 years.
“ How can we give health services for the poor community, we are assigned to collect insurance, taxes and to register member for the political parties, if we say no we will be fired, most of the time the health posts were closed, all services were intercepted, mothers from rural area repeatedly came for immunization, but they did not get us in the health post, those mothers who were educated and have the money for transportation may went to health centers and Hospitals to get immunization service, but the poor mother were waiting us till the health post is opened” Female, Age 39 year.
“One day my 3 years old child was sick and I came to consult the HEW, but, the door is closed and she was not around” Female, FGD discussant, Age 38year, rural community
“Here is the gap, now the health facilities have no plan and willing to give immunization services to marginalized poor people like; beggars around the mosque, church, and on roads. These poor people are totally forgotten, the motivation of health workers to serve this community is almost zero or near to nil. All vaccination mandates are given to HEW, but now health centers and health posts are not connected to these people and their children’s are not vaccinated at all. There is no supervision or support from higher officials, no accountability among HEW “KII M ale, 45yer.
“…Currently only limited budgets are allocated to the health sector, especially for maternal and child health. There are no donors and partners who support the healthcare system; this is probably linked to the current Ethiopian political upheavals. This creates problems for free services for maternal and child care. In my opinion this is the cause of an availability of materials and some drugs at health facility” key-informant-interview, age 44 year.
“Yes, we looked unclean and came from rural areas, the health professionals treated us as not as humans and gave us poor care. They did not touch us by their hands or used apparatus to examine our problem. They simply asked us about our illness and gave us prescription to buy drugs” Female, FGD, 42 years.
Cultural and behavioral barriers
“I have encountered people in some districts who delayed treatment because of traditional beliefs. One of them said … If my child gets sick, I will not bring it to a health facility immediately, I will wait until the disease matures and shows full blown sign can l be observed or till it will resolved by itself” key-informant interview, Male 42 years.
“ in our area some of the rural communities will not send their “children below three months of age” to get immunization services from health facilities before they practice haamchisaa or blessing services from a traditional healer because a bird or the evil eye may see the neonate “ Female, key- informant, 39 years.
“In our area, when their child develops measles some of them refuse to take their children to health facility because they believe that the treatment there will cause girsha, the dissemination of the rash to different organ systems” Male, key-informant, 30 years head of HC.
“I visited a traditional healer for my child when he had tonsil, because drugs and repeated treatment from a health facility are expensive; After the tonsils are removed by a traditional healer there is no recurrence, so it is less costly for me” Female, FG, Age 40 year.
“ Here in the community less attention is given to child health, especially for the newborns; if the newborn dies the dead body will not brought to a church or mosque but it will be buried around the home. Nobody will go to that home to morn with the parents” Male key-informant, 42 years.
“…..Even though Ethiopia is having a diversified ethnic group still there is no marginalization or inequity in utilization of child health services from health facility because of ethnicity; rather they encounter barriers related to language in understanding and to get consultation from service providers” Key-informant, Male, Age 39 year.
Politics, conflict and security issues
“ In our district there is continuous military conflict between the government and rebel forces; most of the time the health facilities were closed, there is diversion of supplies for maternal and child health services to the armed forces, no immunization services was given to the community during this conflict period, roads were closed, the health professionals fled health facilities because they felt insecure, even ambulances assigned to MCH services were used for military purposes;, the rich may get the service from private clinic, the poor did not get anything, simply waiting an interventions from God,, or simply wait to die or migrate to other places” Male, FGD, age 45 years.
“Regarding the issue of security problem, currently in our area there is a military conflict between government and rebellions. Due to this there is no maternal and child healthcare services, 24 h ambulance was served for political purposes, as a result mothers and children are dying from severe anemia and severe pneumonia at their home, therefore, politically instability and conflict among Government and armed rebellion force exacerbate the existed disparity in utilization of healthcare services for mothers and children in our district”. Key –informant, male, age 41 years.