Perceived barriers to health care for residents in vulnerable urban centers of Ethiopia

Abstract

Background: Slums in urban settings are fast expanding and unprecedented proportions of urbanites are now living in slums, with compromised provision of health services. Slum dwellers in urban settings often face multifaceted barriers to accessing available health services. There is a paucity of evidence on identifying barriers in vulnerable urban centers of Ethiopia. This study aims to explore the barriers to the use of health services in slum urban settings of Ethiopia. Methodology: A qualitative study using in-depth and key informant interviews was conducted in 13 selected John Snow, Inc. (JSI) program operational urban areas of Ethiopia. Data were collected from community members, community opinion leaders, Urban Health Extension Professionals, and urban area health office representatives. The interviews were transcribed by data collectors and analyzed using a thematic content analysis approach. Accordingly, individual-, community- and health facility-level barriers were key themes under which findings were categorized. Results: Findings revealed that barriers to health service use at the individual level include limited awareness about health problems, competing priorities and limited capacity to pay for services when referred. Institutional-level barriers include limited medical supplies, and a lack of passion, respect and positive attitudes on the part of health service providers. Barriers at community level include a lack of shared understanding of the problems, services and the community’s established values in relation to the problems and services. Conclusions: The provision of (maternal) health services in slums in Ethiopia’s urban settings is affected by different barriers that work in tandem. The improvement of health service provision in slum settings requires multiple interventions, including strengthening the health system’s responsiveness to health care demand. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):04-11] Key words: Barriers, slum sections of urban centers, community, service providers