Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda

• Published in: Health policy and planning 2017-09, Vol.32 (7), p.934-942
• Main Authors: Allen, Elizabeth Palchik, Muhwezi, Wilson Winstons, Henriksson, Dorcus Kiwanuka, Mbonye, Anthony Kabanza
• Format: Article
• Language: English
• Subjects: Absenteeism; Access; Barriers; Barriers to care; care seeking; Caretakers; Children; Childrens health; Content analysis; distance; Domestic partners; Donors; efficiency; equity; Facilities management; facility management; financial barriers; Focus groups; geographical barriers; Health administration; Health care; Health care facilities; Health facilities; Health services; Help seeking behavior; Infrastructure; Management; Medical personnel; Medical workers; Medicin och hälsovetenskap; Original; ORIGINAL ARTICLES; Personal finance; Planners; Policy making; Professionalism; Qualitative analysis; Qualitative research; social accountability; Staffing; Uganda; Workforce planning
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czw180

While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8–10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important—and increasingly popular among national planners and donors–it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach – and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming – and given the limited resource envelopes that policymakers often have at their disposal – attention to the barriers considered most vital among caretakers in different settings should be weighed. S’il est vrai que plusieurs études fournissent des renseignements sur les divers obstacles auxquels les personnes en charge des enfants de moins de cinq ans sont souvent confrontées lorsqu’elles veulent accéder à des soins de santé en Ouganda, peu d’études se sont intéressées à la hiérarchisation que ces tuteurs font des obstacles qu’ils rencontrent eux-mêmes au cours de la recherche des services de santé. Nous avons, à cet effet, demandé à des groupes représentatifs de tuteurs, de produire une liste des cin