Original Research

Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study

Luke B. Profitt, Graham Bresick, Liezel Rossouw, Ben Van Stormbroek, Tasleem Ras, Klaus Von Pressentin
South African Family Practice | Vol 65, No 1 : Part 4| a5754 | DOI: https://doi.org/10.4102/safp.v65i1.5754 | © 2023 Luke B. Profitt, Graham Bresick, Liezel Rossouw, Ben van Stormbroek, Tasleem Ras, Klaus von Pressentin | This work is licensed under CC Attribution 4.0
Submitted: 28 March 2023 | Published: 20 December 2023

About the author(s)

Luke B. Profitt, Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town; and Western Cape Government Health and Wellness, Cape Town, South Africa
Graham Bresick, Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Liezel Rossouw, Western Cape Government Health and Wellness, False Bay Hospital, Cape Town, South Africa
Ben Van Stormbroek, Western Cape Government Health and Wellness, Victoria Hospital, Wynberg, Cape Town; and Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Tasleem Ras, Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Klaus Von Pressentin, Department of Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

Background: In Cape Town, the under-5 mortality rate has plateaued to 20 per 1000 live births, with 60% of child deaths occurring out of hospital. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths. This study aimed to uncover the access barriers and facilitators underlying this high burden of out-of-hospital deaths.

Methods: An exploratory mixed-methods case study design employed three data collection strategies: a quantitative survey with randomly sampled community members, semi-structured interviews with purposively sampled caregivers whose children presented critically ill or deceased (January 2017 – December 2020) and a nominal group technique (NGT) to build solution-oriented consensus among purposively sampled health workers, representing different levels of care in the local health system.

Results: A total of 62 community members were surveyed, 11 semi-structured caregiver interviews were conducted, and 11 health workers participated in the NGT. Community members (74%) experienced barriers in accessing care. Knowledge of basic home care for common conditions was limited. Thematic analysis of interviews showed affordability, acceptability, and access, household and facility factor barriers. The NGT suggested improvement in community-based services, transport access and lengthening service hours would facilitate access.

Conclusion: While multiple barriers to accessing care were identified, facilitators addressing these barriers were explored. Healthcare planners should examine the barriers within their geographic areas of responsibility to reduce child deaths.

Contribution: This study uncovers community perspectives on childhood out-of-hospital deaths and makes consensus-based recommendations for improvement.


Keywords

barriers; facilitators; healthcare access; children; low-income area

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