Patient referral patterns in Namibia: identification of potential to improve the efficiency of the health care system

Low, Anne; Coeyere, Dirk de; Shivute, Nestor; Brandt, Laura

doi:10.1002/hpm.628

Cited by 28 publications

(28 citation statements)

References 5 publications

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“…Preference for higher level facilities has been reported in several other studies in Tanzania [11,12], as well as from other low-income countries [7-9]. In a study conducted in Tanzania, 44% of the women seeking birth care had bypassed their nearest facility while 59.8% of women who lived in a village with a functioning health facility had delivered at home [11].…”

Section: Discussionmentioning

confidence: 90%

Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

Kahabuka

Kvåle

Moland³

et al. 2011

BMC Health Serv Res

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BackgroundResearch on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them.MethodsThe study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania.ResultsThe questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348) of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%), lack of drugs (15.5%), closed health facility (10.2%), poor services (9.7%) and lack of skilled health workers (3.4%). In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity.Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them.ConclusionThe observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to improve quality of care at available facilities could be more appropriate for improving access to health care than increasing the number of facilities. This would also improve equity in health care access since the poor who can not afford travelling costs will then get access to quality services at their nearer PHC facilities.

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Section: Discussionmentioning

confidence: 90%

Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

Kahabuka

Kvåle

Moland³

et al. 2011

BMC Health Serv Res

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“…However, several studies [8][9][10][11] have documented poor quality of services in most of these facilities causing majority of the care-seekers to bypass them while seeking child care.…”

Section: Introductionmentioning

confidence: 99%

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

Ahmed¹

2017

SJPH

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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.

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“…The current indications of a reduction in disease mortality and morbidity in both malaria and HIV are due to an integrated approach to diagnosis, treatment and monitoring. Simplified NAATs, such as LAMP, to enable improved diagnosis of TB could still have a huge impact on disease diagnosis if integrated with a functioning referral system and combined with HIV diagnosis and treatment [37,38].…”

Section: Usable Resultsmentioning

confidence: 99%

Nucleic acid detection and quantification in the developing world

Huggett

Green

Zumla

2009

Biochemical Society Transactions

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Techniques using nucleic acid amplification have not had the same amount of impact on research and clinical diagnosis in the developing world as that observed in the West. This is unsurprising when the costs and infrastructure required to perform nucleic acid amplification are considered. Despite this, nucleic acid amplification is being increasingly used in both research and diagnosis in countries such as Zambia and Tanzania. Scientific research in the developing world is made possible through the support and development of the necessary laboratory infrastructure and the establishment of special transport for the reagents and samples. This has enabled world-leading country-relevant research to be performed by local scientists on subjects ranging from rapid diagnosis of infectious diseases to measuring the RNA gene expression in an immune response. Concomitantly, the challenge presented by the need for tests that are more appropriate for a resource-poor setting has led to a number of newer methodologies for nucleic acid detection, which can be tailored to be performed in the field without the need for training in molecular biology. As nucleic acid amplification techniques become both simpler and cheaper, their impact is likely to play an increasingly crucial role in research and diagnosis in the developing world.

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Patient referral patterns in Namibia: identification of potential to improve the efficiency of the health care system

Cited by 28 publications

References 5 publications

Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

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

Nucleic acid detection and quantification in the developing world

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