Barriers to Access of Healthcare Services for Rural Women-Applying Gender Lens on TB in a Rural District of Sindh, Pakistan.

Shifa Salman Habib,Anna Versfeld,Srichand Batra,Syed Mohammad Asad Zaidi,Jacob Creswell,Wafa Zehra Jamal,Hira Mustafa Khan,Junaid-Ur-Rehman Siddiqui

doi:10.3390/ijerph181910102

Shifa Salman Habib, Anna Versfeld + Show 6 more

Open Access

https://doi.org/10.3390/ijerph181910102

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Abstract

Background: Women in the rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for the disease of tuberculosis (TB). This study was conducted to assess the general understanding of TB and for women’s access to healthcare, as a first step towards implementation of a gender responsive TB program in Tando Allahyar, a rural district of Pakistan. Methods: A total of 36 participants were interviewed for the study. The focus group discussion guide comprised of questions on: (1) family/household dynamics, (2) community norms, (3) healthcare systems, (4) women’s access to healthcare, (5) TB Awareness, and (6) women’s access to TB Care. Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access healthcare for women, which is even higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. Conclusion: Significant barriers are faced by women in accessing TB care in rural districts of Pakistan. Program implementers in high burden countries should shift towards improved gender-responsive TB programming.

Highlights

Gender is an important determinant of health, in low-and-middle income countries (LMICs) [1,2] The importance of addressing gender inequalities in access to health care is well established in literature
National TB programs should be informed by and respond to the ways in which gender effects individual, household and community practices that may increase the risk of TB and influence health seeking behavior
We further showed that young women, who locally demonstrate a higher TB burden than men of the same cohort, were reported to experience greater challenges in TB care access than older women

Summary

Introduction

Gender is an important determinant of health, in low-and-middle income countries (LMICs) [1,2] The importance of addressing gender inequalities in access to health care is well established in literature. Previous studies from multiple LMICs in African and South Asian regions have reported women to have experienced greater barriers to healthcare compared to men, resulting in overall poorer health outcomes and higher mortality [3,4,5,6,7]. A recent study from Pakistan reports lower uptake of community-based TB screening services among women despite a higher age standardized prevalence of active. Pakistani society is highly patriarchal, and gender-based disparities are common between women and men in health, education, income opportunities, employment opportunities, personal security, control over assets and participation in politics [9,10] Pakistan ranks 151st on the World Economic Forum’s Global Gender Gap Report, third from last on the list [11].

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