Dear HIFA and HIFA-Zambia,
'According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%)' This is the main finding of a paper from Kenya, Tanzania, Uganda and Zambia. Citation, abstract and a comment from me below.
CITATION: Healthcare workers’ perspectives on access to sexual and reproductive health services in the public, private and private not-for-profit sectors: insights from Kenya, Tanzania, Uganda and Zambia
Gaby I. Ooms et al.
BMC Health Services Research volume 22, Article number: 873 (2022) Cite this article
Background: Access to sexual and reproductive health services remains a challenge for many in Kenya, Tanzania, Uganda and Zambia...
Methods: A cross-sectional survey was conducted among healthcare workers working in health facilities offering sexual and reproductive health services in Kenya (n = 212), Tanzania (n = 371), Uganda (n = 145) and Zambia (n = 243)...
Results: According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%). Following, issues with supply of commodities (42.5%) and frequent stockouts (36.0%) were most often raised in the public sector; in the other sectors these were also raised as an issue. Patient costs were a more significant barrier in the private (33.3%) and private not-for-profit sectors (21.1%) compared to the public sector (4.6%), and religious beliefs were a significant barrier in the private not-for-profit sector compared to the public sector (odds ratio = 2.46, 95% confidence interval = 1.69–3.56). In all sectors delays in the delivery of supplies (37.4-63.9%) was given as main stockout cause. Healthcare workers further believed that it was common that clients were reluctant to access sexual and reproductive health services, due to fear of stigmatisation, their lack of knowledge, myths/superstitions, religious beliefs, and fear of side effects. Healthcare workers recommended client education to tackle this.
Conclusions: Demand and supply side barriers were manifold across the public, private and private not-for-profit sectors, with some sector-specific, but mostly cross-cutting barriers. To improve access to sexual and reproductive health services, a multi-pronged approach is needed, targeting client knowledge, the weak supply chain system, high costs in the private and private not-for-profit sectors, and religious beliefs.
The authors conclude that: 'Efforts should focus on improving knowledge through client education, HCW sensitisation and education regarding unhelpful religious and cultural beliefs, improving supply chain systems through strengthening logistic management information systems, training staff in supply chain management, and allocating sufficient budget to commodity procurement.'
COMMENT (NPW): This paper confirms yet again the importance of access to reliable, relevant healthcare information. However, the author's concluding sentence "Efforts should..." cannot be derived on the basis of a relatively small survey of health workers' perceptions. What is needed is more research on the role of (lack of) healthcare information (among patients and health workers) vis a vis other drivers/barriers to high-quality care.