02 May 2013

Article: "Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania"

Article by Helle Samuelsen, Department of Anthropology, University of Copenhagen; Britt Pinkowski Tersbøl , Department of International Health, Immunology and Microbiology, University of Copenhagen; and Selemani Said Mbuyita, Ifakara Health Institute, Tanzania, in BMC Health Services Research 2013, vol. 13, February 2013 .

Delays in treatment of poor children
Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers.

The overall objective in this article is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies.

Qualitative study of the delays at a health-care facility
This study is focused on exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility.

The study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis.

Four obstacles affect poor mothers particularly hard
Four main obstacles have been identified;

  • confusions over payment,
  • inadequate referral systems,
  • the inefficient organization of health services
  • and the culture of communication.

These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as ‘technologies of social exclusion’, as they are embedded in the everyday practices of the health facilities in systematic ways.

The interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system.

Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively.

Read the full article here (Open Access – PDF).