Barasa Violet, Virhia Jennika
The Institute of Development Studies, University of Sussex, Brighton, United Kingdom.
The Institute of Health and Wellbeing, School of Social and Political Science, The University of Glasgow, Glasgow, United Kingdom.
Front Glob Womens Health. 2022 Jan 28;2:746402. doi: 10.3389/fgwh.2021.746402. eCollection 2021.
Research has shown that gender is a significant determinant of health-seeking behavior around the world. Gender power relations and lay etiologies of illness can influence the distribution of household resources, including for healthcare. In some rural settings in Africa, gender intersects with multiple forms of health inequities, from proximal socio-cultural factors to more "upstream" or distal health system determinants which can amplify barriers to health-seeking for specific groups in specific contexts.
We used an intersectionality approach to determine how women in particular, experience gendered barriers to accessing healthcare among Maa and non-Maa speaking agro-pastoralists in northern Tanzania. We also explored lay etiologies of febrile illness, perceptions of health providers and rural health-seeking behavior in order to identify the most common barriers to accessing healthcare in these settings.
Mixed method ethnographic approaches were used to collect data between 2016 and 2018 from four Maa-speaking and two Swahili-speaking agro-pastoralist villages in northern Tanzania. Maa-speaking villages were based in Naiti, Monduli district while non-Maa speaking villages were selected from Msitu in Babati district. Data on health seeking behaviors was collected through semi-structured questionnaires, in-depth interviews, focus group discussions, and home and facility-based participant observation.
The results primarily focus on the qualitative outcomes of both studies. We found that febrile illness was locally categorized across a spectrum of severity ranging from normal and expected illness to serious illness that required hospital treatment. Remedial actions taken to treat febrile illness included attending local health facilities, obtaining medicines from drug sellers and use of herbal remedies. We found barriers to health-seeking played out at different scales, from the health system, community (inter-household decision making) and household (intra-household decision making). Gender-based barriers at the household had a profound effect on health-seeking. Younger married women delayed seeking healthcare the most, as they often had to negotiate health-seeking with husbands and extended family members, including co-wives and mothers-in-law who make the majority of health-related decisions.
An intersectional approach enabled us to gain a nuanced understanding of determinants of health-seeking behavior beyond the commonly assumed barriers such lack of public health infrastructure. We propose tapping into the potential of senior older women involved in local therapy-management groups, to explore gender-transformative approaches to health-seeking, including tackling gender-based barriers at the community level. While these social factors are important, ultimately, improving the public health infrastructure in these settings is a first step toward addressing structural determinants of treatment-seeking.
研究表明，性别是全球寻求医疗行为的一个重要决定因素。性别权力关系和疾病的民间病因会影响家庭资源的分配，包括医疗保健资源。在非洲的一些农村地区，性别与多种形式的健康不平等相互交织，从近端的社会文化因素到更“上游”或远端的卫生系统决定因素，这些因素会在特定背景下加剧特定群体寻求医疗的障碍。
我们采用交叉性方法来确定坦桑尼亚北部说马赛语和非马赛语的农牧民中，女性在获取医疗保健方面如何经历性别障碍。我们还探讨了发热疾病的民间病因、对医疗服务提供者的看法以及农村的就医行为，以便找出这些地区获取医疗保健最常见的障碍。
2016年至2018年期间，采用混合方法人种志研究方法，从坦桑尼亚北部四个说马赛语和两个说斯瓦希里语的农牧民村庄收集数据。说马赛语的村庄位于蒙杜利区的奈蒂，非马赛语村庄则从巴巴蒂区的姆西图选取。通过半结构化问卷、深入访谈、焦点小组讨论以及家庭和医疗机构参与观察等方式收集就医行为数据。
结果主要聚焦于两项研究的定性结果。我们发现，发热疾病在当地根据严重程度分为不同类别，从正常和预期的疾病到需要住院治疗的严重疾病。治疗发热疾病采取的补救措施包括前往当地医疗机构、从药品销售商处获取药品以及使用草药疗法。我们发现，寻求医疗的障碍在不同层面发挥作用，包括卫生系统、社区（家庭间决策）和家庭（家庭内决策）。家庭层面基于性别的障碍对寻求医疗有深远影响。年轻已婚女性寻求医疗的延迟最为严重，因为她们常常要与丈夫和大家庭成员（包括共同妻子和婆婆，她们做出大多数与健康相关的决策）协商就医事宜。
交叉性方法使我们能够更细致入微地理解寻求医疗行为的决定因素，而不仅仅局限于诸如缺乏公共卫生基础设施等常见假设的障碍。我们建议挖掘参与当地治疗管理小组的老年女性的潜力，探索寻求医疗的性别变革方法，包括解决社区层面基于性别的障碍。虽然这些社会因素很重要，但最终，改善这些地区的公共卫生基础设施是解决寻求治疗的结构决定因素的第一步。
