Amy W Blasini1,2, Peter Waiswa2,3, Phillip Wanduru2, Lucky Amutuhaire4, Cheryl A Moyer5. 1. University of Michigan Medical School, Ann Arbor, Michigan, United States of America. 2. Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda. 3. Department of Global Public Health, Karolinska Institutet, Solna, Sweden. 4. Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda. 5. Departments of Learning Health Sciences and OB/GYN, University of Michigan, Ann Arbor, Michigan, United States of America.
Abstract
BACKGROUND: Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities. METHODS: This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. RESULTS: 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking. DISCUSSION: This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.
BACKGROUND: Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities. METHODS: This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. RESULTS: 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking. DISCUSSION: This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.
Authors: E W Kimani-Murage; J C Fotso; T Egondi; B Abuya; P Elungata; A K Ziraba; C W Kabiru; N Madise Journal: Health Place Date: 2014-07-11 Impact factor: 4.078
Authors: Li Liu; Shefali Oza; Dan Hogan; Yue Chu; Jamie Perin; Jun Zhu; Joy E Lawn; Simon Cousens; Colin Mathers; Robert E Black Journal: Lancet Date: 2016-11-11 Impact factor: 79.321
Authors: Stephanie A Kujawski; Lynn P Freedman; Kate Ramsey; Godfrey Mbaruku; Selemani Mbuyita; Wema Moyo; Margaret E Kruk Journal: PLoS Med Date: 2017-07-11 Impact factor: 11.069
Authors: Hannah L Ratcliffe; David Sando; Goodluck Willey Lyatuu; Faida Emil; Mary Mwanyika-Sando; Guerino Chalamilla; Ana Langer; Kathleen P McDonald Journal: Reprod Health Date: 2016-07-18 Impact factor: 3.223
Authors: Elizabeth Palchik Allen; Wilson Winstons Muhwezi; Dorcus Kiwanuka Henriksson; Anthony Kabanza Mbonye Journal: Health Policy Plan Date: 2017-09-01 Impact factor: 3.344