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'It's about time': policymakers' and health practitioners' perspectives on implementing fertility care in the Gambian health system.
Afferri, Anna; Dierickx, Susan; Allen, Haddijatou; Bittaye, Mustapha; Marena, Musa; Pacey, Allan; Balen, Julie.
Afiliação
  • Afferri A; School of Health and Related Research- ScHARR, The University of Sheffield, Sheffield, UK. anna.afferri@gmail.com.
  • Dierickx S; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
  • Allen H; Research Centre Gender, Diversity and Intersectionality - RHEA, Vrije Universiteit, Brussel, Belgium.
  • Bittaye M; Medical Research Council- MRC Unit The Gambia at LSHTM, Fajara, The Gambia.
  • Marena M; The Gambia Ministry of Health, Banjul, The Gambia.
  • Pacey A; School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
  • Balen J; The Gambia Ministry of Health, Banjul, The Gambia.
BMC Health Serv Res ; 24(1): 282, 2024 Mar 05.
Article em En | MEDLINE | ID: mdl-38443896
ABSTRACT

BACKGROUND:

Infertility is a major health issue worldwide, yet very few examples of interventions addressing infertility in the Global South have been documented to date. In The Gambia, West Africa, infertility is recognised as a burden and the health authorities have included it in several health policies and the new National Reproductive Health Strategy however, a detailed operationalisation plan for fertility care has not yet been established. Here, we aim to understand and document the factors that influence the implementation of fertility care in The Gambia.

METHODS:

We conducted 46 semi-structured interviews with policymakers, implementers, and health practitioners in both the public and private sectors from July to November 2021. The interviews were transcribed, anonymised and analysed with NVivo Pro version 1.6.1. The analysis was initially inductive, with themes arising from the coding categorised according to the WHO health systems building blocks framework.

RESULTS:

This study identified several barriers to a successful implementation of fertility care in The Gambia, including (i) a lack of routinely collected infertility data; (ii) an absence of financial protection mechanisms for patients, and/or a specific budget for infertility; (iii) limited cooperation between the public and private sectors in the provision of fertility care; and (iv) gaps in fertility care training among health practitioners. Conversely, enablers included (i) strong national infertility leadership; and (ii) the integration of infertility care within public reproductive health services.

CONCLUSION:

The Gambian health system is not yet in the position to support a comprehensive fertility care package in its public health facilities. Several aspects of the implementation of fertility care must be considered in operationalising the health strategy including the systematic collection of infertility data, fertility awareness, and the provision of specialised fertility care training. Furthermore, a stronger partnership between the public and private sectors must be developed. Given the increasing availability of assisted reproductive technologies in the sub-Saharan Africa region, and the tendency to locate these technologies in the private sector, further research is needed to understand and identify the processes underlying the implementation of fertility care and to foster better integration with the existing health system.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Preservação da Fertilidade / Infertilidade Limite: Humans País/Região como assunto: Africa Idioma: En Revista: BMC Health Serv Res Assunto da revista: PESQUISA EM SERVICOS DE SAUDE Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Preservação da Fertilidade / Infertilidade Limite: Humans País/Região como assunto: Africa Idioma: En Revista: BMC Health Serv Res Assunto da revista: PESQUISA EM SERVICOS DE SAUDE Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido