SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
BMJ Open. 2023 Nov 22;13(11):e073716. doi: 10.1136/bmjopen-2023-073716.
Despite free primary healthcare services and social protection system for mothers and children, significant nutrition inequalities occur across the globe, including in South Africa. This study aimed to explore what determines mothers' ability to access and turn available services into nutrition benefits.
An exploratory qualitative study was conducted including semistructured interviews with employees from community-based organisations and focus groups with pregnant women and mothers. Discussions focused on existing services perceived as important to nutrition, differences in mothers' ability to benefit from these services, and the underlying unmet needs contributing to these disparities. Data were analysed thematically using a novel social needs framework developed for this study where social needs are defined as the requisites that can magnify (if unmet) or reduce (if met) variation in the degree to which individuals can benefit from existing services.
A resource-constrained urban township, Soweto in Johannesburg.
Thirty mothers of infants (<1 year old) and 21 pregnant women attending 5 primary healthcare facilities participated in 7 focus groups, and 18 interviews were conducted with employees from 10 community-based organisations.
Mothers identified social needs related to financial planning, personal income stability, appropriate and affordable housing, access to government services, social support and affordable healthier foods. The degree to which these needs were met determined mothers' capabilities to benefit from eight services. These were clinic-based services including nutrition advice and social work support, social grants, food aid, community savings groups, poverty alleviation projects, skills training workshops, formal employment opportunities and crèches/school feeding schemes.
Findings demonstrate that while current social protection mechanisms and free health services are necessary, they are not sufficient to address nutrition inequalities. Women's social needs must also be met to ensure that services are accessed and used to improve the nutrition of all mothers and their children.
尽管提供了免费的初级医疗保健服务和母婴社会保护制度，但全球范围内仍存在显著的营养不平等问题，包括南非。本研究旨在探讨是什么决定了母亲获取和利用现有服务获得营养益处的能力。
进行了一项探索性定性研究，包括对社区组织的员工进行半结构式访谈以及对孕妇和母亲进行焦点小组讨论。讨论的重点是现有被认为对营养重要的服务、母亲受益于这些服务的能力差异，以及导致这些差异的未满足的基本需求。使用为这项研究开发的新的社会需求框架对数据进行了主题分析，其中社会需求被定义为可以放大（如果未满足）或缩小（如果满足）个体从现有服务中受益程度差异的必要条件。
约翰内斯堡索韦托的一个资源有限的城市城镇。
参加 5 个初级保健机构的 30 名 1 岁以下婴儿的母亲和 21 名孕妇参加了 7 个焦点小组，对 10 个社区组织的 18 名员工进行了访谈。
母亲们确定了与财务规划、个人收入稳定、适当和负担得起的住房、获得政府服务、社会支持和负担得起的更健康食品相关的社会需求。这些需求的满足程度决定了母亲们从八项服务中受益的能力。这些服务包括诊所提供的服务，如营养咨询和社会工作支持、社会补助金、食品援助、社区储蓄小组、扶贫项目、技能培训研讨会、正规就业机会和托儿所/学校供餐计划。
研究结果表明，尽管当前的社会保护机制和免费医疗服务是必要的，但它们不足以解决营养不平等问题。还必须满足妇女的社会需求，以确保获得和利用服务来改善所有母亲及其子女的营养状况。
