Barriers and facilitators to neonatal health and care-seeking behaviours in rural Cambodia: a qualitative study.

OBJECTIVES: Neonatal mortality remains persistently high in low-income and middle-income countries. In Cambodia, there is a paucity of data on the perception of neonatal health and care-seeking behaviours at the community level. This study aimed to identify influencers of neonatal health and healthcare-seeking behaviour in a rural Cambodian province. DESIGN: A qualitative study using focus group discussions and thematic content analysis. SETTING: Four health centres in a rural province of Northern Cambodia. PARTICIPANTS: Twenty-four focus group discussions were conducted with 85 community health workers in 2019. RESULTS: Community health workers recognised an improvement in neonatal health over time. Key influencers to neonatal health were identified as knowledge, sociocultural behaviours, finances and transport, provision of care and healthcare engagement. Most influencers acted as both barriers and facilitators, with the exception of finances and transport that only acted as a barrier, and healthcare engagement that acted as a facilitator. CONCLUSION: Understanding health influencers and care-seeking behaviours is recognised to facilitate appropriate community health programmes. Key influencers and care-seeking behaviours have been identified from rural Cambodia adding to the current literature. Where facilitators have already been established, they should be used as building blocks for continued change.

Healthcare workers' perceptions of an organizational quality assurance program implemented in a resource-limited setting: a qualitative study.

Background:There is increasing awareness of the need to implement quality assurance programs in developing countries. Healthcare staff are the primary drivers of improving the quality of care,but little is known about how they perceive quality assurance programs in resource-limited settings. This study aims to evaluate healthcare workers' perceptions of the organizational quality assurance program (OQA) at Angkor Hospital for Children (AHC), Cambodia. The OQA involves regular data collection and monitoring of quality indicators, to assess whether agreed quality standards are being met. Methods: This qualitative study consisted of four focus group discussions (FGDs) with 29 hospital staff (convenience sampling) from medical, nursing and non-medical departments. Staff members' understanding of quality assurance and perceptions of the strengths and weaknesses of the OQA were explored. Thematic content analysis was used to identify key themes. Results: Participants emphasized that quality indicators must include physical and psychological well-being. Strengths of the OQA included shared understanding amongst all groups of participants of its goals, committed leadership, that it was locally-relevant and that target indicators were developed from a "ground-up" approach. On-going challenges included that there was a gap in understanding of the OQA processes and overall running of the OQA across the organization between managers and staff. Conclusion: The introduction of the OQA at AHC has been well-received by staff members.Overall, the program is perceived to be valuable. Healthcare provision in resource-limited settings increasingly needs to demonstrate quality assurance. The model of OQA developed at AHC is one way to achieve this.