Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
Health Policy Research Group, Department of Pharmaco-therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
BMC Health Serv Res. 2020 Sep 29;20(1):903. doi: 10.1186/s12913-020-05747-9.
Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria.
Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology.
The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff.
Health facility security should be key consideration in programme planning, to avert staff and women's fear of crime which currently constrains provision and use of maternal healthcare at health facilities.
母婴健康是全球重点关注的问题。在中低收入国家，获得和利用医疗机构服务仍然是一个挑战。关于提供和获取服务障碍的证据忽略了医疗机构内部安全问题的信息。本文探讨了在尼日利亚初级保健机构中，安全在提供和使用产妇保健服务方面所扮演的角色。
该研究在尼日利亚阿南布拉州进行。最初，通过 35 次深入访谈和 24 次焦点小组，从有针对性地确定的主要信息来源收集了定性数据。收集到的信息用于构建一个方案理论，该理论通过另一轮访谈（17 次）和焦点小组（4 次）讨论进行了测试。数据分析和报告基于真实评估方法的情境-机制-结果启发式。
机构内有男性保安的存在是促进服务提供和使用的最重要安全因素。其他因素包括周边围栏、照明和工作人员住宿。缺乏这些因素会限制服务的提供和使用，影响工作人员和患者的行为。机构工作人员对安全的担忧，使他们感到不安全，不愿让未受保护的人员进入机构，这种情况与孕妇的情况类似，因为她们担心无法进入并得到机构工作人员的照顾，从而限制了她们对医疗保健设施的利用。
在规划方案时，应考虑卫生设施安全问题，以避免工作人员和妇女对犯罪的恐惧，目前这种恐惧限制了医疗保健设施中产妇保健服务的提供和使用。
