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Published in: BMC Public Health 1/2021

Open Access 01-12-2021 | Care | Research article

Barriers to the uptake of community-based curative child health services in Ethiopia

Authors: Birkety Mengistu, Meron Paulos, Nesibu Agonafir, Agazi Ameha, Hailemariam Legesse, Elizabeth Dankenbring, Mariame Sylla, Nathan P. Miller

Published in: BMC Public Health | Issue 1/2021

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Abstract

Background

Uptake of services to treat newborns and children has been persistently low in Ethiopia, despite being provided free-of-charge by Health Extension Workers (HEWs). In order to increase the uptake of these services, the Optimizing the Health Extension Project was designed to be implemented in four regions in Ethiopia. This study was carried out to identify barriers to the uptake of these services and potential solutions to inform the project.

Methods

Qualitative data were collected in October and November 2015 in 15 purposely selected districts in four regions. We conducted 90 focus group discussions and 60 in-depth interviews reaching a total of 664 participants. Thematic analysis was used to identify key barriers and potential solutions.

Results

Five demand-side barriers to utilization of health services were identified. Misconceptions about illness causation, compounded with preference for traditional healers has affected service uptake. Limited awareness of the availability of free curative services for children at health posts; along with the prevailing perception that HEWs were providing preventive services only had constrained uptake. Geographic challenge that made access to the health post difficult was the other barrier.
Four supply-side barriers were identified. Health post closure and drug stock-out led to inconsistent availability of services. Limited confidence and skill among HEWs and under-resourced physical facilities affected the service delivery.
Study participants suggested demand creation solutions such as increasing community awareness on curative service availability and educating them on childhood illness causation. Maintaining consistent supplies and ensuring service availability; along with regular support to build HEWs’ confidence were the suggested supply-side solutions. Creating community feedback mechanisms was suggested as a way of addressing community concerns on the health services.

Conclusion

This study explored nine demand- and supply-side barriers that decreased the uptake of community-based services. It indicated the importance of increasing awareness of new services and addressing prevailing barriers that deprioritize health services. At the same time, supply-side barriers would have to be tackled by strengthening the health system to uphold newly introduced services and harness sustainable impact.
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Footnotes
1
The newborn mortality rate was 29 per 1000 live births according to the EDHS, 2016.
 
2
PATH is an international, non-profit global health organization based in Seattle with 70+ offices around the world including Ethiopia.
 
3
UNICEF works within the United Nations in over 190 countries including Ethiopia to help children survive, thrive and fulfill their potential, from early childhood through adolescence.
 
4
Regions are administratively further divided into progressively smaller areas: zones, woredas (districts) and kebeles (sub-districts).
 
5
As most residents in the Gurage zone speak Amharic, the data collectors used the Amharic data collection tools and translated it to Gruagina during the interview as needed.
 
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Metadata
Title
Barriers to the uptake of community-based curative child health services in Ethiopia
Authors
Birkety Mengistu
Meron Paulos
Nesibu Agonafir
Agazi Ameha
Hailemariam Legesse
Elizabeth Dankenbring
Mariame Sylla
Nathan P. Miller
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-021-11558-2

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