Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
Makerere University School of Public Health, SPEED Project, Kampala, Uganda.
BMJ Open. 2021 Dec 2;11(12):e045575. doi: 10.1136/bmjopen-2020-045575.
This study explored the experiences of accessing care across the border in East Africa.
From February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279 household adults residing along selected national border sites of Uganda, Kenya and Rwanda and had accessed care from the opposite side of the border 5 years prior to this study.
Access to HIV treatment, maternal delivery and childhood immunisation services was explored. We applied the health access framework and an appreciative inquiry approach to identify factors that enabled access to the services.
Exploratory factor analysis and linear regression were used for quantitative data, while deductive content analysis was done for the qualitative data on respondent's experiences navigating health access barriers.
The majority of respondents (83.9%; 234/279) had accessed care from public health facilities. Nearly one-third (77/279) had sought care across the border more than a year ago and 22.9% (64/279) less than a month ago. From the linear regression, the main predictor for ease of access for healthcare were ''ease of border crossing' (regression coefficient (RegCoef) 0.381); 'services being free' (RegCoef 0.478); 'services and medicines availability' (RegCoef 0.274) and 'acceptable quality of services' (RegCoef 0.364). The key facilitators for successful navigation of access barriers were related to the presence of informal routes, speaking a similar language and the ability to pay for the services.
Communities resident near national borders were able to cross borders to seek healthcare. There is need for a policy environment to enable East Africa invest better and realise synergies for these communities. This will advance Universal Health Coverage goals for communities along the border who represent the far fang areas of the health system with multiple barriers to healthcare access.
本研究探讨了在东非跨境获取医疗服务的经历。
2018 年 2 月至 6 月，采用定性和定量方法，对居住在乌干达、肯尼亚和卢旺达选定国家边境地区的 279 户家庭成年人进行了横断面研究，这些成年人在本研究前 5 年曾从边境另一侧获得过医疗服务。
探讨了获得艾滋病毒治疗、产妇分娩和儿童免疫服务的情况。我们应用卫生服务获取框架和欣赏式探究方法，确定了促进获取这些服务的因素。
对定量数据采用探索性因子分析和线性回归，对受访者在获取卫生服务障碍方面的经验的定性数据采用演绎内容分析。
大多数受访者（83.9%，234/279）曾从公立卫生机构获得过医疗服务。近三分之一（77/279）的人在一年多前曾跨境寻求医疗服务，22.9%（64/279）的人在一个月前寻求过医疗服务。线性回归结果显示，医疗保健易于获取的主要预测因素包括“边境过境便利”（回归系数（RegCoef）为 0.381）、“服务免费”（RegCoef 为 0.478）、“服务和药品供应”（RegCoef 为 0.274）和“服务质量可接受”（RegCoef 为 0.364）。成功克服获取障碍的关键促进因素与存在非正式途径、使用相似语言以及支付服务费用的能力有关。
居住在国家边境附近的社区能够跨境寻求医疗服务。需要有一个政策环境，使东非更好地投资，并为这些社区实现协同增效。这将推进边境地区社区的全民健康覆盖目标，这些社区代表着卫生系统的偏远地区，面临着多种医疗服务获取障碍。
