International Journal for Equity in Health | |
Community perceptions and factors influencing utilization of health services in Uganda | |
George W Pariyo1  Stefan Peterson5  Andrew State4  Sandro Galea2  Sarah P Wamala3  Solome K Bakeera6  | |
[1] Department of Policy and Planning, Makerere University School of Public Health, Kampala, Uganda;Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, USA;Current:Swedish National Institute of Public Health, Ostersund and Karolinska Institutet, Stockholm, Sweden;Faculty of Social Sciences, Makerere University, Kampala, Uganda;Divison of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden | |
Others : 834270 DOI : 10.1186/1475-9276-8-25 |
|
received in 2009-01-15, accepted in 2009-07-14, 发布年份 2009 | |
![]() |
【 摘 要 】
Background
Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization.
Study Objective
To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda.
Methods
We used a qualitative study design using Focus Group Discussions (FGD) to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest') using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings.
Results
Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as important in overcoming utilization barriers. However, there are indications that having access to social resources may compensate for the lack of material resources in relation to use of health care services mainly for the least poor wealth category.
Conclusion
The differential patterning of social resources may explain or contribute to the persisting inequities in health care utilization. Additional research using quantitative analytical methods is needed to test the robustness of the contribution of social resources to the utilization of and access to healthcare services.
【 授权许可】
2009 Bakeera et al; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140715054646955.pdf | 254KB | ![]() |
【 参考文献 】
- [1]Makenbach JP, Looman CWN, Kunst AE, Habbema DF, Maas PJ: Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical interventions in the Netherlands. Soc Sci Med 1988, 27:889-94.
- [2]Bonneaux L, Looman CW, Barendregt JJ, van der Maas PJ: Regression analysis of recent changes in cardiovascular morbidity and mortality in the Netherlands. BMJ. 1997, 314(7083):789-792.
- [3]Bayo A, Albert X, Alfonso JL, Cortina P, Corella D: The effectiveness of health systems in influencing avoidable mortality: a study in Valencia, Spain, 1975–90. J Epidemiol Community Health 1996, 50:320-25.
- [4]Obrist B, Iteba N, Lengeler C, Makemba A, Mshana C, Nathan R, et al.: Access to Health Care in Contexts of Livelihood Insecurity: A Framework for Analysis and Action. PLos Medicine 2007, 4(10):1584-8.
- [5]World Health Organization, editor: Declaration of Alma-Ata. In Intern Conference on Primary Healthcare. Alma-Ata, USSR; 1978.
- [6]Gulliford M, Figueroa-Munoz J, Morgan M, et al.: What does 'access to health care' mean? J Health Serv Res Policy 2002, 7(3):186-8.
- [7]Sepehri A, Moshiri S, Simpson W, Sarma S: Taking account of context: how important are household characteristics in explaining adult health-seeking behavior? The case of Vietnam. Health Policy Plan. 2008, 23(6):397-407.
- [8]Uganda Ministry of Health: Health Sector Strategic Plan I . 2000/01–2004/05 2000.
- [9]Uganda Ministry of Health: Health Sector Strategic Plan II . 2005/06–2006/07 2005.
- [10]Uganda Ministry of Health: Health sector Strategic Plan Mid Term Review Report. 2003.
- [11]Uganda Ministry of Health: Health sector Strategic Plan Mid Term Review Report. 2008.
- [12]Makerere University Institute of Public Health: Affordability Ladder Patterns First Year Progress Report. 2004.
- [13]Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH: Poverty and access to healthcare in developing countries. Ann N Y Acad Sci 2008, 1136:161-71.
- [14]Wamala SP, Merlo J, Boström G, Hogstedt C: Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007, 61(5):409-415.
- [15]Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, et al.: Inequities among the very poor: health care for children in rural southern Tanzania. Lancet. 2003, 361(9357):561-566.
- [16]Gwatkin DR, Bhuiya A, Victora CG: Making health systems more equitable. The Lancet 2004, 364:1273-80.
- [17]Tuller DM, Bangsberg DR, Senkungu J, Ware CN, Emenyoumu N, Weiser SD: Transportation costs impede sustained adherence and access to HAART in a clinic population in Southwestern Uganda: a qualitative study. AIDS Behaviour 2009, in press.
- [18]Hjortsberg C: Why do the sick not use health care? The case of Zambia. Health Economics 2003, 12(9):155-70.
- [19]La Vecchia C, Negri E, Pagano R, Decarli E: Education, prevalence of disease and frequency of health care utilisation. The 1983 Italian National Health Survey
- [20]Kasirye I, Ssewanyana S, Nabyonga J, Lawson D: Demand for health care services in Uganda: implications for poverty reduction. 2004.
- [21]Blakely T, Ivory V: Commentary: Bonding, bridging, and linking-but still not much going on. Intern J Epidemiology 2006, 35:614-5.
- [22]Kavanagh AM, Turrell G, Subramanian SV: Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania International Journal of Epidemiology 2006, 35:607-13.
- [23]Kawachi I, Kennedy BP: Income inequality and health: pathways and mechanisms. Health Serv Res 1999, 34(1 Pt 2):215-27.
- [24]Kaplan GA: What is the role of the social environment in understanding inequalities in health. In Socioeconomic status and health in industrial nations Edited by Adler NE, Marmot M, McEwen BS, Stewart S. 1999.
- [25]Kaplan GA: What's wrong with social epidemiology, and how can we make it better? Epidemiologic Reviews John Hopkins Bloomberg School of Public Health 2004, 26.
- [26]Link BG, Phelan JC: Social conditions as the fundamental causes of disease. Journal of Health and Social Behaviour 2004, (extra):80-94.
- [27]Hendryx MS, Ahern MM, Lovrich NP, McCurdy AH: Access to healthcare and community social capital. Health Serv Res 2002, 37(1):87-103.
- [28]Mohseni M, Lindstrom M: Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study. Soc Sci Med. 2007, 64(7):1373-1383.
- [29]Kawachi I: Commentary: social capital and health: making the connections one step at a time. International Journal of Epidemiology 2006, 35:989-93.
- [30]Lin N, Fu Y: Social Capital: Social Resources, Civic Engagement, or Trust? The annual meeting of the American Sociological Association. Atlanta Hilton Hotel, Atlanta, GA 2003.
- [31]Putnam RD, Leonardi R, Nanetti R: Making democracy work civic traditions in modern Italy. N.J: Princeton University Press; 1993.
- [32]Ayé M, Champagne F, Contandriopoulos AP: Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast. Soc Sci Med 2002, 55(11):1929-46.
- [33]Leive A, Xu K: Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bulletin of the World Health Organization 2008, 86(11):817-908.
- [34]Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, et al.: Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006, 62(4):866-876.
- [35]Wamani H, Tylleskar T, Astrom AN, Tumwine JK, Peterson S: Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. International Journal for Equity in Health 2004., 3(9)
- [36]Rutebemberwa E, Kallander K, Tomson G, Peterson S, Pariyo G: Determinants of delay in care-seeking for febrile children in eastern Uganda. Tropical Medicine and International Health 2009, 14(4):1-8.
- [37]Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Peters D, Hafizur RM, et al.: Access to and utilization of health services for the poor in Uganda: A systematic review of available evidence. Trans R Soc Trop Med Hyg 2008, 102(11):1067-74.
- [38]Lucas H, Nuwagaba A: Household coping strategies in response to the introduction of user charges of social services: a case study on health in Uganda. Institute of Development Studies 1999.
- [39]Iganga, District, Local, Government. Annual Health District Work-Plan 2007.
- [40]Theis J, Grady H: Participatory Rapid Appraisal for Community Development. A Training Manual Based on Experiences in the Middle East and North Africa: International Institute for Environment and Development & Save the Children; 1991.
- [41]Powell AR, Single HM: Methodolgy Matters – V: Focus Groups. International Journal for Quality in Health care 1996, 8(5):499-504.
- [42]Lucas H, Nuwagaba A: Household coping strategies in response to the introduction of user charges of social services: a case study on health in Uganda. Institute of Development Studies (IDS), Sussex, UK; 1999.
- [43]Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358(9280):483-488.
- [44]Aguti J: Facing up to the challenge of Universal Primary Education (UPE) in Uganda through distance teacher education programmes. Pan commonwealth conference on open learning; Durban, South Africa 2002.
- [45]Lin N: Social capital: a theory of social structure and action. New York: Cambridge University Press; 2001.
- [46]Granovetter MS: The strength of weak ties. AJS 1973, 78(6):1369-80.
- [47]Woolcock M, Narayan D: Social Capital: implications for development theory, research, and policy. The World Bank Research Observer 2000, 15(2):225-49.
- [48]Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Rahman MH: Poverty and access to healthcare in developing countries. Ann N Y Acad Sci 2008, 1136:161-71.