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Barriers to accessing and utilising under-five primary health care services in Vhembe District
Livhuwani Tshivhase1, Idah Moyo, Sophie M Mogotlane
1Department of Nursing, School of Health Care, Sefako Makgatho Health Sciences University, Pretoria. livhuwani.tshivhase@smu.ac.za.
Insights
Barriers in accessing primary health care (PHC) for children under five in South Africa include health system issues, personnel behavior, facility infrastructure, and guardian-related factors. Addressing these is crucial for improving child health outcomes.
Area of Science:
- Public Health
- Pediatrics
- Health Services Research
Background:
- Sub-Saharan Africa faces the highest global under-five mortality rate.
- Primary health care (PHC) services for children under five are free in South Africa but access remains a challenge.
- Treatable childhood illnesses like pneumonia, diarrhea, and malaria contribute to under-five mortality.
Purpose of the Study:
- To explore barriers in accessing and utilizing under-five primary health care (PHC) services.
- Focus on the Vhembe District to understand specific contextual challenges.
Main Methods:
- Interpretative phenomenology design utilizing semi-structured individual interviews.
- Purposive sampling of 16 participants (guardians of under-five children).
- Colaizzi's steps for data analysis, ensuring trustworthiness and ethical principles.
Main Results:
- Four major themes of barriers identified: health system, health personnel behavior, health facility infrastructure, and guardian-related factors.
- Subthemes include distance, resource limitations, long waiting times, poor staff attitude, inadequate facilities (water, sanitation), and guardian beliefs.
- Urgency of illness also emerged as a significant factor influencing access.
Conclusions:
- Creating an enabling and professional environment is essential for improving PHC access for under-five children.
- Guardian context must be considered to enhance the quality of care for young children.
- Addressing identified barriers can reduce under-five mortality and improve child health outcomes.
Background:
Sub-Saharan Africa continues to be the region with the highest under-five mortality rate globally, with 74 deaths per 1000 live births. Even though under-five child primary health care (PHC) services are free in South Africa, accessing such services remains challenging. Children under 5 years reportedly die from common illnesses such as pneumonia, diarrhoea and malaria, which are treatable in PHC facilities.
Aim:
The study explored the barriers to accessing and utilising under-five PHC services in the Vhembe District.
Setting:
The study was conducted in two PHC centres in Vhembe District among guardians accessing care for under-five child health services.
Methods:
An interpretative phenomenology design was followed using a semi-structured individual interview guide. Sixteen participants were purposively sampled for the study. Colaizzi's steps of data analysis were followed, and trustworthiness as well as ethical principles were ensured throughout the study.
Results:
Four themes emerged as health system barriers, health personnel-related behaviours, health facility infrastructure barriers and guardians-related barriers. Subthemes emerged as distance from the facility, lack of resources, long waiting times; poor time management, lack of commitment and work devotion, insufficient waiting space; challenges with water and sanitation, guardians' healthcare beliefs and the urgency of the illness.
Conclusion:
It is imperative that an enabling professional and friendly environment is created to facilitate better access to PHC services for children under 5 years.Contribution: The study's findings brought insight into considering the context of the guardians in improving quality care for under 5 years.
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