Factors influencing the low utilization of curative child health services in Shebedino District, Sidama Zone, Ethiopia
Tefera, W.; Tesfaye, H.; Bekele, A.; Kayessa, E.; Waltensperger, K.Z.; Marsh, D.R.
Ethiopian Medical Journal 52(Suppl 3): 109-117
2014
ISSN/ISBN: 0014-1755 PMID: 25845080 Document Number: 674106
Use and coverage of curative interventions for childhood pneumonia, diarrhea, and malaria were low in Ethiopia before integrated community-based case management (iCCM). To examine factors accounting for low use of iCCMin Shebedino District applying a "Pathway to Sur- vival" approach to assess illness recognition; home care; labeling and decision-making; patterns of care-seeking; access, availability and quality of care; and referral. Shortly after introduction of iCCM, we conducted five studies in Shebedino District in May 2011: a population-based household survey; focus group discussions of mothers of recently ill children; key informant in- terviews, including knowledge assessment, with Health Extension Workers at health posts and with health workers at health centers; and an inventory of drugs, supplies, and job aids at health posts and health centers. The many barriers to use of evidence-based treatment included: (1) home remedies of uncertain effect and safety that delay care-seeking; (2) absent decision-maker; (3) fear of stigma; (4) expectation of non-availability of service or medicine; (5) geographic and financial barriers; (6) perception of (or actual) poor quality of care; and (7) accessible, available, affordable, reliable, non-standard, alternative sources of care. Only a system-strengthening approach can overcome such manifold barriers to use of curative care that has not increased much after ICCM introduction.