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Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia
- Source :
- BMC Health Services Research, Vol 17, Iss 1, Pp 1-11 (2017), BMC Health Services Research
- Publication Year :
- 2017
- Publisher :
- BMC, 2017.
-
Abstract
- Background There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas. Method Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability. Results Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment. Conclusions This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2282-4) contains supplementary material, which is available to authorized users.
- Subjects :
- medicine.medical_specialty
Health seeking behaviour
030231 tropical medicine
Access to health services
Health Promotion
Vulnerable Populations
Health Services Accessibility
Health administration
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
Nursing
parasitic diseases
Health care
Medicine
Humans
030212 general & internal medicine
Socioeconomics
Health policy
Qualitative Research
Health equity
Community health workers
business.industry
Health Policy
Public health
lcsh:Public aspects of medicine
1. No poverty
lcsh:RA1-1270
medicine.disease
3. Good health
Malaria
Forest workers
Health promotion
Mobile populations
Rural area
business
Cambodia
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 17
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Health Services Research
- Accession number :
- edsair.doi.dedup.....8f07792892c54ccf9eb59ba8f7f2fe0e