Cargando…

Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa

BACKGROUND: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing ca...

Descripción completa

Detalles Bibliográficos
Autores principales: Goudge, Jane, Gilson, Lucy, Russell, Steven, Gumede, Tebogo, Mills, Anne
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694171/
https://www.ncbi.nlm.nih.gov/pubmed/19426533
http://dx.doi.org/10.1186/1472-6963-9-75
_version_ 1782168048291020800
author Goudge, Jane
Gilson, Lucy
Russell, Steven
Gumede, Tebogo
Mills, Anne
author_facet Goudge, Jane
Gilson, Lucy
Russell, Steven
Gumede, Tebogo
Mills, Anne
author_sort Goudge, Jane
collection PubMed
description BACKGROUND: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. METHODS: A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. RESULTS: In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. CONCLUSION: In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.
format Text
id pubmed-2694171
institution National Center for Biotechnology Information
language English
publishDate 2009
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-26941712009-06-09 Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa Goudge, Jane Gilson, Lucy Russell, Steven Gumede, Tebogo Mills, Anne BMC Health Serv Res Research Article BACKGROUND: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. METHODS: A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. RESULTS: In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. CONCLUSION: In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance. BioMed Central 2009-05-09 /pmc/articles/PMC2694171/ /pubmed/19426533 http://dx.doi.org/10.1186/1472-6963-9-75 Text en Copyright © 2009 Goudge et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Goudge, Jane
Gilson, Lucy
Russell, Steven
Gumede, Tebogo
Mills, Anne
Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title_full Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title_fullStr Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title_full_unstemmed Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title_short Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa
title_sort affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694171/
https://www.ncbi.nlm.nih.gov/pubmed/19426533
http://dx.doi.org/10.1186/1472-6963-9-75
work_keys_str_mv AT goudgejane affordabilityavailabilityandacceptabilitybarrierstohealthcareforthechronicallyilllongitudinalcasestudiesfromsouthafrica
AT gilsonlucy affordabilityavailabilityandacceptabilitybarrierstohealthcareforthechronicallyilllongitudinalcasestudiesfromsouthafrica
AT russellsteven affordabilityavailabilityandacceptabilitybarrierstohealthcareforthechronicallyilllongitudinalcasestudiesfromsouthafrica
AT gumedetebogo affordabilityavailabilityandacceptabilitybarrierstohealthcareforthechronicallyilllongitudinalcasestudiesfromsouthafrica
AT millsanne affordabilityavailabilityandacceptabilitybarrierstohealthcareforthechronicallyilllongitudinalcasestudiesfromsouthafrica