RESUMO
OBJECTIVE: The aim of this study was to identify the underlying causes of Cambodian women's non-use of maternal health services provided by skilled birth attendants. METHOD: A qualitative study of 66 reproductive-age women was conducted in Kampong Cham Province, Cambodia. Data were collected through 30 semi-structured interviews and 6 focus groups. RESULTS: We identified 5 barriers to the utilization of maternal health services: (i) financial barriers; (ii) physical barriers; (iii) cognitive barriers; (iv) organizational barriers; and (v) psychological and socio-cultural barriers. CONCLUSIONS: The Cambodian Ministry of Health and its development partners should take these barriers into account when promoting the use of maternal health services. These barriers should be addressed proactively. A successful approach to increasing use of maternal health services should involve changes to both service programs and public education.
Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/organização & administração , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Serviços de Saúde Rural/estatística & dados numéricos , Camboja , Competência Clínica , Tomada de Decisões , Feminino , Grupos Focais , Pesquisas sobre Atenção à Saúde , Humanos , Medicina Tradicional do Leste Asiático , Modelos Psicológicos , Mães/educação , Mães/estatística & dados numéricos , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários , ViagemRESUMO
The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002-2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia.