Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti.
BMJ Open
; 11(11): e047367, 2021 11 22.
Article
in English
| MEDLINE | ID: covidwho-1528550
ABSTRACT
OBJECTIVE:
To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access.DESIGN:
Cross-sectional study. SETTING ANDPARTICIPANTS:
In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled. OUTCOMEMEASURES:
Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis.RESULTS:
Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar's χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional.CONCLUSION:
Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Patient Acceptance of Health Care
/
Health Services Accessibility
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Traditional medicine
Limits:
Child
/
Humans
Country/Region as subject:
Caribbean
/
Haiti
Language:
English
Journal:
BMJ Open
Year:
2021
Document Type:
Article
Affiliation country:
Bmjopen-2020-047367
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