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The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger
BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what e...
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2004
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC400759/ https://www.ncbi.nlm.nih.gov/pubmed/15059284 http://dx.doi.org/10.1186/1478-4491-2-1 |
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author | Bossyns, Paul Van Lerberghe, Wim |
author_facet | Bossyns, Paul Van Lerberghe, Wim |
author_sort | Bossyns, Paul |
collection | PubMed |
description | BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns. |
format | Text |
id | pubmed-400759 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2004 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-4007592004-05-02 The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger Bossyns, Paul Van Lerberghe, Wim Hum Resour Health Research BACKGROUND: For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own. METHODS: Information was triangulated from three sources in two rural districts in Niger: first, 46 semi-structured interviews with health centre nurses; second, 42 focus group discussions with an average of 12 participants – patients, relatives of patients and others; third, 231 semi-structured interviews with referred patients. RESULTS: Passive patients without 'voice' reinforce authoritarian attitudes of health centre staff. The latter appear reluctant to refer because they see little added value in referral and fear loss of power and prestige. As a result staff communicates poorly and show little eagerness to convince reluctant patients and families to accept referral proposals. CONCLUSIONS: Diminishing referral costs and distance barriers is not enough to correct failing referral systems. There is also a need for investment in district hospitals to make referrals visibly worthwhile and for professional upgrading of the human resources at the first contact level, so as to allow for more effective referral patterns. BioMed Central 2004-04-01 /pmc/articles/PMC400759/ /pubmed/15059284 http://dx.doi.org/10.1186/1478-4491-2-1 Text en Copyright © 2004 Bossyns and Van Lerberghe; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. |
spellingShingle | Research Bossyns, Paul Van Lerberghe, Wim The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title | The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title_full | The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title_fullStr | The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title_full_unstemmed | The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title_short | The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger |
title_sort | weakest link: competence and prestige as constraints to referral by isolated nurses in rural niger |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC400759/ https://www.ncbi.nlm.nih.gov/pubmed/15059284 http://dx.doi.org/10.1186/1478-4491-2-1 |
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