Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2012 Jun 14;12:158. doi: 10.1186/1472-6963-12-158.
There is growing evidence that patients frequently bypass primary health care (PHC) facilities in favour of higher level hospitals regardless of substantial additional time and costs. Among the reasons given for bypassing are poor services (including lack of drugs and diagnostic facilities) and lack of trust in health workers. The World Health Report 2008 "PHC now more than ever" pointed to the importance of organizing health services around people's needs and expectations as one of the four main issues of PHC reforms. There is limited documentation of user's expectations to services offered at PHC facilities. The current study is a community extension of a hospital-based survey that showed a high bypassing frequency of PHC facilities among caretakers seeking care for their underfive children at two district hospitals. We aimed to explore caretakers' perceptions and expectations to services offered at PHC facilities in their area with reference to their experiences seeking care at such facilities.
We conducted four community-based focus group discussions (FGD's) with 47 caretakers of underfive children in Muheza district of Tanga region, Tanzania in October 2009.
Lack of clinical examinations and laboratory tests, combined with shortage of drugs and health workers, were common experiences. Across all the focus group discussions, unpleasant health workers' behaviors, lack of urgency and unnecessary delays were major complaints. In some places, unauthorized fees reduced access to services.
The study revealed significant disappointments among caretakers with regard to the quality of services offered at PHC facilities in their areas, with implications for their utilization and proper functioning of the referral system. Practices regarding partial drugs administrations, skipping of injections, unofficial payments and consultations by unskilled health care providers need urgent action. There is also a need for proper accountability mechanisms to govern appropriate allocation and monitoring of health care resources and services in Tanzania.
越来越多的证据表明，患者经常绕过基层医疗保健（PHC）设施，转而选择更高层次的医院，而不管这会带来大量额外的时间和成本。患者选择绕过 PHC 设施的原因包括服务差（包括缺乏药物和诊断设施）以及对卫生工作者缺乏信任。《世界卫生报告 2008 年：初级卫生保健如今比以往任何时候都更重要》指出，将卫生服务围绕人们的需求和期望来组织，是 PHC 改革的四个主要问题之一。关于患者对 PHC 设施提供的服务的期望，文献记载有限。本研究是对一项以医院为基础的调查的社区延伸，该调查显示，在坦桑尼亚坦噶地区的两家地区医院，照顾者为其五岁以下儿童寻求医疗服务时，经常绕过 PHC 设施。我们旨在探讨照顾者对其所在地区 PHC 设施提供的服务的看法和期望，同时参考他们在这些设施寻求医疗服务的经验。
我们于 2009 年 10 月在坦噶地区的穆希扎区，对 47 名五岁以下儿童的照顾者进行了四次基于社区的焦点小组讨论（FGD）。
缺乏临床检查和实验室检查，加上药物和卫生工作者短缺，是常见的经历。在所有的焦点小组讨论中，卫生工作者态度不佳、缺乏紧迫感和不必要的拖延是主要的抱怨。在一些地方，未经授权的收费降低了服务的可及性。
该研究揭示了照顾者对其所在地区 PHC 设施提供的服务质量存在显著失望，这对他们对这些设施的利用以及转诊系统的正常运作产生了影响。部分药物管理、跳过注射、非官方付款和非专业医疗保健提供者的咨询等做法需要紧急采取行动。此外，还需要适当的问责机制来管理坦桑尼亚卫生保健资源和服务的适当分配和监测。
