Sahelie Birhanu, Baertlein Luke, Dubad Bashir AIi, Osman Mohammed, Post Nathan, Stringer Beverley, Piening Turid, Majanen Hanna, Damulak Istifanus Chindong, Van Boetzalaer Elburg, Kuehne Anna, Keating Patrick
Médecins Sans Frontières, Addis Ababa, Ethiopia.
Médecins Sans Frontières, Wardher, Ethiopia.
BMC Health Serv Res. 2025 Jan 28;25(1):158. doi: 10.1186/s12913-025-12282-y.
The Somali region in Ethiopia has poor health infrastructure, coupled with the adversity experienced by the largely pastoralist population through frequent droughts, disease outbreaks and conflict. From January 2019, MSF strategically focused on improving access to primary healthcare in the Doolo zone of the Somali region by providing 15-20 mobile clinics covering a wide geographical area. We aimed to evaluate the extent to which mobile clinics were an appropriate and effective modality to deliver healthcare for populations living in the region.
In this mixed-methods study, we conducted a descriptive analysis of 24 months of routine mobile clinic data (February 2019 to January 2021) to evaluate the appropriateness and effectiveness of mobile clinics. We conducted a patient satisfaction survey to assess perceived benefits and challenges, as well as seven interviews with MSF medical staff and four focus group discussions with community members from mobile clinic sites to explore the appropriateness, effectiveness, and connectedness of mobile clinics.
MSF mobile clinics conducted 90,542 outpatient consultations, across 30 mobile clinic sites during the two-year period. However, there were gaps in continuity of care. The ratio of follow-up-to-first antenatal care visits was 0.82, and the ratio of third-to-first dose of DTP/Hib/HepB vaccine was 0.39. The current mobile clinic strategy is generally well perceived by the community in terms of the quality of services provided. However, MSF staff and community members expressed that its appropriateness and effectiveness are limited by mobile clinic opening hours, large patient volumes, referral policies, staffing, and drug supply issues.
Limited opening hours, large patient volumes, weak referral processes and supply issues impacted the appropriateness and effectiveness of healthcare provision by mobile clinics to this pastoralist population. These challenges are consistent with those faced by mobile clinics in other contexts. To enhance the effectiveness and appropriateness of mobile clinics for pastoralist populations requires collaboration with both community members and local authorities to design and regularly review the locations, frequency, healthcare service package and referral policies of mobile clinics.
埃塞俄比亚的索马里地区卫生基础设施薄弱，而以畜牧业为主的人口又经常遭受干旱、疾病爆发和冲突等逆境。自2019年1月起，无国界医生组织从战略上聚焦于改善索马里地区多洛区的初级医疗服务可及性，通过提供15至20个流动诊所，覆盖广阔的地理区域。我们旨在评估流动诊所在多大程度上是为该地区居民提供医疗服务的合适且有效方式。
在这项混合方法研究中，我们对24个月的流动诊所常规数据（2019年2月至2021年1月）进行了描述性分析，以评估流动诊所的合适性和有效性。我们开展了患者满意度调查，以评估感知到的益处和挑战，并对无国界医生组织的医务人员进行了7次访谈，以及与流动诊所所在地的社区成员进行了4次焦点小组讨论，以探讨流动诊所的合适性、有效性和关联性。
在两年期间，无国界医生组织的流动诊所在30个流动诊所地点进行了90,542次门诊咨询。然而，在连续护理方面存在差距。产前护理复诊与首次就诊的比例为0.82，白喉、破伤风、百日咳、b型流感嗜血杆菌结合疫苗/乙肝疫苗第三剂与第一剂的比例为0.39。就所提供服务的质量而言，社区总体上对当前的流动诊所策略评价良好。然而，无国界医生组织的工作人员和社区成员表示，其合适性和有效性受到流动诊所开放时间、患者数量众多、转诊政策、人员配备和药品供应问题的限制。
开放时间有限、患者数量众多、转诊流程薄弱和供应问题影响了流动诊所为该牧民人口提供医疗服务的合适性和有效性。这些挑战与其他情况下流动诊所所面临的挑战一致。为提高流动诊所对牧民人口的有效性和合适性，需要与社区成员和地方当局合作，设计并定期审查流动诊所的地点、频率、医疗服务包和转诊政策。
