The referral process and urban health care in sub-Saharan Africa: the case of Lusaka, Zambia

Atkinson, Sarah; Ngwengwe, A; Macwan’gi, Mubiana; Ngulube, T.J.; Harpham, Trudy; O'Connell, Andrew

doi:10.1016/s0277-9536(99)00072-6

Cited by 59 publications

(47 citation statements)

References 6 publications

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“…Poor functionality of services in government managed health centres led to clients bypassing facilities for MNH services. This finding confirms with the existing evidence that poorly functioning government facilities is a motivating factor to deliver at home (2), purchase services from healthcare shop (21), or turn to higher level facilities for primary care (22). Facility related constraints were only minor issues in communities residing in contracted sites but were a noticeable constraint in non-contracted sites.…”

Section: Discussionsupporting

confidence: 88%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong communitybased behavior change strategies. Implications for policy makers• Contracting out public health facilities can be an effective strategy to improve service delivery for Maternal and Neonatal Health (MNH), however, not sufficient to improve the service utilization. • With poor physical and financial access to health facilities in rural settings, transportation and financial safety nets need to be established. • Cultural and customary trends strongly influence decision-making for MNH services utilization. Therefore, community-based behavior change strategies targeting mothers, spouses and mother-in-laws seem crucial.

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Section: Discussionsupporting

confidence: 88%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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“…This deterioration occurs because very large numbers of people simply cannot afford necessary health care [224-227]. Ethnographic research and the experiences of front-line care providers [100,195,228] support the conclusion that the issue is often not one of unwillingness to pay, but rather of inability to pay, and understandable reluctance to sell off assets that may be critical to the household's economic survival [224,229].…”

Section: Introductionmentioning

confidence: 99%

Globalization and social determinants of health: The role of the global marketplace (part 2 of 3)

Labonté

Schrecker

2007

Global Health

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Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives.In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic.In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace.

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“…It imposes overburden on the specialized health facilities as revealed by another study also in another developing country (10). Unfortunately this burden is more due to the common ailments rather than cases requiring specialized care.…”

Section: Discussionmentioning

confidence: 99%

Utilization Of The Health Care Delivery System In A District Of North India

Bhola¹,

Kumari²,

Nidha³

2009

East Afr. J. Pub. Health

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Background: India has one of the most extensive health infrastructures-a three-tier hierarchical referral system-for the provision of effective and efficient health services to the majority of its population. In this study we have tried to evaluate the utilization of such a wide health infrastructure and the various factors affecting it. We have also tried to find the factors that motivated the patients to visit the present health facility and the key persons who motivated them to do so. Methods: Time bound cross-sectional study. Setting: Three types of referral health facilities in Lucknow District Participants: A total of 1265 patients were interviewed during the four months of the period of survey from these three types of referral health facilities. Results: The present study revealed that majority of the patients coming to all the three referral centres were the new patients (89%), about two-thirds of whom had come there directly. Overall, only one tenth of the patients attending the secondary and tertiary level public health facilities were referred by someone. Most of the indirect patients had self referred themselves. About eight and nine percent of the indirect and referred patients could reach the present site of treatment only after more than two years of rummaging and about 13% and 11% had spent more than ten thousand rupees respectively, which in some cases even amounted to lakh rupees. Conclusions: The utilization of the referral system of the health care delivery in India needs to be augmented. Before planning future reforms such as decentralization, incorporation of the Indian system of Medicine, and other steps we need to develop mechanisms to see that the plans are materialized.

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The referral process and urban health care in sub-Saharan Africa: the case of Lusaka, Zambia

Cited by 59 publications

References 6 publications

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Globalization and social determinants of health: The role of the global marketplace (part 2 of 3)

Utilization Of The Health Care Delivery System In A District Of North India

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