一项关于取消用户收费后加纳孕产妇和新生儿医疗保健服务可及性和利用方面卫生系统障碍的定性研究。
A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition.
作者信息
Ganle John Kuumuori, Parker Michael, Fitzpatrick Raymond, Otupiri Easmon
机构信息
Department of Geography and Rural Development, Population, Health and Gender Studies Group, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Nuffield Department of Population Health, The Ethox Centre, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom.
出版信息
BMC Pregnancy Childbirth. 2014 Dec 21;14:425. doi: 10.1186/s12884-014-0425-8.
BACKGROUND
To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikingly high maternal mortality ratio and low percentage of skilled attendance are still recorded in many parts of the country. To explore health system factors that inhibit women's access to and use of skilled maternal and newborn healthcare services in Ghana despite these services being provided free.
METHODS
We conducted qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana between November 2011 and May 2012. We used Attride-Stirling's thematic network analysis framework to analyze and present our data.
RESULTS
We found that in addition to limited and unequal distribution of skilled maternity care services, women's experiences of intimidation in healthcare facilities, unfriendly healthcare providers, cultural insensitivity, long waiting time before care is received, limited birthing choices, poor care quality, lack of privacy at healthcare facilities, and difficulties relating to arranging suitable transportation were important health system barriers to increased and equitable access and use of services in Ghana.
CONCLUSION
Our findings highlight how a focus on patient-side factors can conceal the fact that many health systems and maternity healthcare facilities in low-income settings such as Ghana are still chronically under-resourced and incapable of effectively providing an acceptable minimum quality of care in the event of serious obstetric complications. Efforts to encourage continued use of maternity care services, especially skilled assistance at delivery, should focus on addressing those negative attributes of the healthcare system that discourage access and use.
背景
为减少获得医疗服务的经济障碍，并改善孕产妇和新生儿获得熟练医护服务的机会及利用情况，加纳政府于2003年实施了一项新的孕产妇保健政策，在所有公立和教会医疗机构提供免费孕产妇保健服务。尽管加纳的产妇在医护人员监督下分娩的比例已从2003年的47%增至2010年的55%，但该国许多地区仍记录到极高的孕产妇死亡率和较低的熟练接生率。为探究尽管已免费提供这些服务，但仍阻碍加纳妇女获得和利用孕产妇及新生儿熟练医护服务的卫生系统因素。
方法
2011年11月至2012年5月期间，我们在加纳的六个社区对185名孕妇和哺乳期妇女以及20名医护人员进行了定性研究。我们使用阿特里德 - 斯特林的主题网络分析框架来分析和呈现我们的数据。
结果
我们发现，除了熟练孕产妇保健服务分布有限且不均衡外，妇女在医疗机构受到恐吓的经历、不友好的医护人员、文化上的不敏感、接受护理前等待时间过长、分娩选择有限、护理质量差、医疗机构缺乏隐私以及安排合适交通方面的困难，都是加纳增加和公平获得及利用服务的重要卫生系统障碍。
结论
我们的研究结果凸显了关注患者方面因素如何可能掩盖这样一个事实，即在加纳等低收入环境中的许多卫生系统和孕产妇保健机构长期资源不足，在出现严重产科并发症时无法有效提供可接受的最低护理质量。鼓励持续使用孕产妇保健服务，尤其是分娩时的熟练协助的努力，应侧重于解决阻碍获得和利用服务的卫生系统的那些负面属性。
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