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Table 5 Solutions and recommendations forwarded by health professionals in Sidama region on the health service utilisation of Dale and Wonsho districts, 2018, Sidama, Ethiopia

From: Low and unequal use of outpatient health services in public primary health care facilities in southern Ethiopia: a facility-based cross-sectional study

Recommendation from district health officials and health centre managers

Recommendation from Sidama Regional Health Bureau

Theme 1: Budget allocations and alternative sources

Ensuring and creating awareness on the community-based health insurance scheme.

“Most of the rural community thinks why would I have the community-based insurance, I might not be sick at all. But in reality our community spends more out of pocket.... Therefore, if we could convince and create awareness about the insurance, the frequency of the visit will increase.”

 

Allocating enough budgets for health facilities; and support those people who are very poor and orphans, and unable to pay for health services through healthcare financing.

“The kebeles should identify genuinely those who are the “poorest of the poor” and provide all services free of charge. Most people don’t come to health facility due to financial issue.”

Theme 2: Sustainable drug and material supply

Supplying and ensuring availability of medical supplies or equipment like essential medications, laboratory reagents (diagnostic materials), physical examination apparatuses to provide quality health service.

“The main problem I think is lack of medications in the health centres, because of repeated encounter to get some of the medications from us, the community tends to go to other facilities.”

Ensuring availability of different laboratory tests with high specificity; including hematologic tests for accurately identifying anaemia, diabetes, other infections and febrile illnesses; blood chemistry; urine analysis and culture.

“At the primary health level the availability and quality of laboratory tests in doubtful. The tests, if available, lack specificity. They mostly rely on making diagnosis based on signs or symptoms, and this could lead to misdiagnose or make wrong diagnosis”

“We don’t have functioning blood pressure measurement apparatus, such issues makes it to make accurate diagnosis.”

Shortage of drugs and other supplies may affect service utilisation, because patients may prefer private clinics rather than government health facilities for these reasons.

“One of the issues here is if someone didn’t get drugs or laboratory test from the nearby health centre, he or she will go to other places.”

Theme 3: Health workers capacity building

Creating a compassionate, respectful and caring (CRC) health workforce by giving training and supervision to improve their attitudes.

“Training on CRC will improve the health professionals attitude and patients need such services”

Augment the knowledge and skill of health workers through short- and long-term training.

 Preparing manuals and give training on different components like community mobilisation.

“Health extension workers need more training so that they can equip the community about the services being given at health post and health centre level”

“Strengthening integrated community case management, community-based newborn care, and integrated management of neonatal and childhood illness services are important to improve the diagnostic capacity.”

To improve the diagnostic capacity of health facilities, further training, provision of more laboratory technicians and test kits may be recommended.

“Training whether short term or long term will improve the knowledge and skill of the health professionals, to make accurate diagnoses”

Provide counselling and on-the-job and refreshment training to health professionals to halt negligence or malpractice by health professionals.

“Regular counselling and refreshment trainings should be given to health professionals, this will help in improving malpractices in their day to day practice”

 

Theme 4: Quality of services

 

Working to make the health facilities function per the standards will increase the quality of care, which intern will improve the utilisation.

“For example, stabilisation centre service utilisation for severely malnourished children is low. This may be due to the fact that not all health centres and hospitals are providing services as per standard due to shortage of meals for caretakers, lack of trained staff and shortage of stabilisation centre kits. Therefore, working to mitigate these factors in collaboration with other stakeholders might be a solution.”

Theme 5: Access of health facilities

Strengthening linkages between the district health offices and health centres, and between health centres and health posts, by creating timely and smooth lines of communication.

Building maternity waiting rooms will improve access related problem.

“The lower postnatal care utilisation shows that almost all primary health care units are not keeping mothers at the health facilities at least for 24 h after delivery. This may be due to a shortage of maternity waiting rooms because most government health facilities have incomplete premises and infrastructure.”

Plan to increase the number of health facilities.

“Due to the geographical inaccessibility of our woreda (Wonsho), more health facilities should be constructed to increase utilisation”

Some health facilities are not accessible throughout the week for 24 h.

“Even though health-seeking behaviour of the community was improved, most health posts may be closed during working hours and health centres do not provide some services the entire week. Therefore, ensuring delivery of service at all times could increase utilisation.”

Theme 6: Public and stakeholders involvement and collaboration

The public should be involved from planning to implementation of health services. The health extension workers also should focus on creating awareness on health care seeking behaviour. Every gathering should be taken as a venue for awareness creation. Moreover, collaboration with other non-governmental organisations might alleviate problems with capacity building, material supply and infrastructure.

“Involving women health development armies, who are volunteer community health workers responsible for mobilising the community, during planning and training them on implementation issues.”

“Encourage health extension workers to strictly work on house-to-house visits and educating the community about health service utilisation.”

“Giving health education about health services in different locations like health facilities, schools, community gatherings etc.

“Creating and strengthening communication with other stakeholders like non-governmental organisations.”

 

Theme 7: Supervision and record keeping

Enhance recording and reporting system by giving on-the-job and refreshment training and supportive supervision.

 

Timely supportive supervision, follow-up and feedback (monitoring and evaluation) should be strengthened to enhance the commitment of health professionals.

“We have missed information due to poor documentation and negligence; anything not recorded is considered as not being done. Therefore, training and supervisions should focus on these areas too.”