Exploration of facilitators of and barriers to the community-based service utilization for newborn possible serious bacterial infection management in Debre Libanos District, Ethiopia: descriptive qualitative study

Abstract

Background: Globally, possible serious bacterial infection [PSBI] is a cause for about 600,000 newborn deaths per year. To decrease the burden of this infection, a community-based management newborn PSBI when referral to hospital is not possible has been on implementation. Studies showed gaps in the service utilization and this study was aimed at exploring its barriers and facilitators. Methods: A descriptive qualitative study was conducted from March 11-April 7, 2019, in Debre Libanos District, Ethiopia. Study participants were recruited purposively. Women who gave birth within 2 months before data collection, health extension workers [HEW], health workers, religious leader, kebele chairman, and other community members were involved in the study. Five in-depth interviews, seven key informant interviews, and four focused group discussions were conducted with a total of fifty-two participants. The data were audio-recorded, transcribed verbatim and translated, and inductive thematic analysis was done using Atlas ti.7.1 software. Result: The availability of health workers trained on community-based newborn care [CBNC], Integrated Management of Newborn and Childhood Illness guidelines, availability of medical supplies and job aids, and performance review meetings were identified as facilitators. Communities perception that the newborn illness has no medical treatment, newborn illness is not severe and is self-resolution; the belief in healing power of traditional medicines, socio-cultural and religious beliefs, lack of awareness about service availability at the health post, poor supportive supervision or monitoring, shortage of HEW, the residency of HEWs outside the health post, a poor commitment of health workers and HEWs, and non-functionality of health developmental army were explored as barriers.

Barriers for the Functional Implementation of Community Health Volunteers in Health Developmental Army in Debre Libanos District, Oromia, Ethiopia: A Descriptive Qualitative Study

“…To ensure the trustworthiness of the study findings, different techniques were used. 15,24,26,27 First, the guiding questions were developed concerning the research objectives and pretested at a neighboring district. Second, data were collected from diversified groups of participants recruited from six kebeles.…”

“…For instance, a study conducted in the current study setting indicates that the HDAs team leaders were not functional or did not conduct activities expected from them. 15 Existing evidence indicated that the performance of community health workers was challenged from lack or irregularity of supportive supervision, high workload without monetary compensation, lack of family support, or lack of motivation or appreciation. [9][10][11][16][17][18][19][20] However, little was known about the barriers affecting their functionality in the study setting or the context of our country, Ethiopia.…”

Using the Implementation Research Logic Model to design and implement community-based management of possible serious bacterial infection during COVID-19 pandemic in Ethiopia

“…Ethiopia introduced community-based newborn care (CBNC) in its flagship Health Extension Program (HEP) to improve access to and use of appropriate treatment for neonatal sepsis when a referral was not possible in 2012 [17]. However, the coverage of sick newborn care is low due to multiple factors: an overall decline in the performance of the HEP observed in recent years [18], low Health Extension Workers' (HEWs) competency and motivation [9,19,20], erratic supply of essential drugs [19,20], suboptimal supportive and referral links [9,19,20], communities' misperceptions about newborn illnesses [21,22], and socio-cultural beliefs and mothers' limited decision-making power [19,[21][22][23]. In addition, there is a concern from program managers that the Coronavirus (COVID-19) pandemic has stressed the already weak healthcare system in Ethiopia, exacerbating the already fragile newborn and child health services.…”

Management of bacterial infections in young infants in Ethiopia: Facility preparedness, health workers’ knowledge and quality of care

“…Despite the introduction of the community‐based newborn care programme, service utilisation for possible serious bacterial infection remains low 11,12 . Lack of awareness of the availability of services, inaccessibility of facilities, and socioeconomic and cultural factors have been identified as barriers to service utilisation 13 . For those who sought care at health facilities, the quality of care has been suboptimal 14 .…”

“…11,12 Lack of awareness of the availability of services, inaccessibility of facilities, and socioeconomic and cultural factors have been identified as barriers to service utilisation. 13 For those who sought care at health facilities, the quality of care has been suboptimal. 14 Poor service quality is a major global driver for excess mortality in the neonatal period and across a range of age groups and conditions.…”