Bypassing Primary Health Care Facilities for Common Childhood Illnesses in Sharg-Alneel Locality in Khartoum State, Sudan 2015

Abstract

Abstract:In Sudan despite the current implementation of universal health coverage policy, routine monitoring reports highlight that patients frequently bypass Primary Health Care (PHC) facilities in favor of higher-level hospitals, though hospitals are costly and time consuming. The main objective of this study was to study the extent of bypassing the public PHC facilities and factors associated with the decision of caretakers to bypass such facilities seeking care for their under-five year's children with common illnesses in Sharg-Alneel locality, 2015. The study proposed strategies and interventions to the Sudan government -Federal Ministry of Health (FMoH) -to improve PHC service utilization The study was cross-sectional comparative study, interviewer administered questionnaires and facility assessment checklist was used for data collection. The data was analysed using SPSS. The study interviewed 497 caretakers, 87% of them pursued health care for their children directly from secondary hospitals. The main reasons for bypassing the closest public health facilities were unavailability of doctors, lack of health insurance services and higher cost of services. The proportion of bypassing a PHC facility for child care is significantly associated with child sex, child age, presenting symptoms of diarrhea, fever, difficult breathing and severe vomiting, caretakers' occupation as well as the economic status. In a resource limited country, health policy to achieve universal health coverage is better to focus on quality of care as well as quantity. Community mobilization and interventions to improve access and utilization of quality PHC services are all recommended. Furthermore, more research on bypassing behaviour is also recommended.

Determinants of pregnant mothers to bypass primary health facilities and directly seek postnatal care in hospitals in Dar es Salaam region – A Community health needs assessment, Cross Sectional Study

“…These results were in keeping with other studies conducted in Sharg-Alneel Locality in Khartoum State Sudan by Ahmed, et al (2015) found primary healthcare facility bypass was very high at 87% of them pursued healthcare for their children directly from secondary hospitals [13]. Kante, et al, (2016) on the other side also established that more than 75.4% bypassed the primary facilities in rural Tanzania which is lower than this study has established [8].…”

“…Likewise, in Ghana Yafee, et al [12] established that, 33.9% was the total rate of bypassing a local facility and in Sudan, Ahmed, et al [13] found that primary health facility bypass was very high at 87%…”

“…Ahmed, et al (2015) in Sudan identified the reasons for bypassing the closest public health facilities, which were unavailability of doctors, lack of health insurance services and higher cost of services. [13] The extent of bypass as well as determinants for bypass is not clear in Dar es Salaam, although policy guidelines on health system and referral system are available, there is a gap in terms of adherence to that system. Despite having a large number of primary facilities, it appears that the hospitals are more overwhelmed with patients compared to the lower facilities.…”

Self-referral practice and associated factors among women who gave birth in South Gondar zone primary hospitals, Northwest Ethiopia: a cross-sectional study design

“…The finding of this study was lower as compared with studies conducted in DCSH, Ethiopia (63.9%) ( 25 ), Western Ethiopia (82 and 84%) ( 4 , 35 ), Indonesia (66%) ( 10 ), Nigeria (70%) ( 12 ), and Sudan (87%) ( 11 ) of outpatients who were self-referred. This difference might be due to a difference in the study population, which means labor is acute and progressive; women may not be able to walk as far as outpatients.…”