Abstract
In Sudan despite the current implementation of universal health coverage policy, routine monitoring reports highlight that patients frequently bypass Primary Health Care (PHC) facilities in favor of higher-level hospitals, though hospitals are costly and time consuming. The main objective of this study was to study the extent of bypassing the public PHC facilities and factors associated with the decision of caretakers to bypass such facilities seeking care for their under-five year’s children with common illnesses in Sharg-Alneel locality, 2015. The study proposed strategies and interventions to the Sudan government -Federal Ministry of Health (FMoH) - to improve PHC service utilization The study was cross- sectional comparative study, interviewer administered questionnaires and facility assessment checklist was used for data collection. The data was analysed using SPSS. The study interviewed 497 caretakers, 87% of them pursued health care for their children directly from secondary hospitals. The main reasons for bypassing the closest public health facilities were unavailability of doctors, lack of health insurance services and higher cost of services. The proportion of bypassing a PHC facility for child care is significantly associated with child sex, child age, presenting symptoms of diarrhea, fever, difficult breathing and severe vomiting, caretakers’ occupation as well as the economic status. In a resource limited country, health policy to achieve universal health coverage is better to focus on quality of care as well as quantity. Community mobilization and interventions to improve access and utilization of quality PHC services are all recommended. Furthermore, more research on bypassing behaviour is also recommended.
Highlights
The provision of Primary Health Care (PHC) services in Sudan is arranged across four levels of services according to the population size
This was a cross sectional comparative study to measure the proportion and clients reasons for bypassing PHC facilities. This was complemented by assessment of all primary health facilities bypassed by the interviewed caretakers to explore facility as well as providers factors related to bypassing PHC services
With respect to the caretaker’s nationality and relationship, the findings indicated that the proportion of caretakers who bypassed public PHC facilities were 93% Sudanese and 85%biological mothers
Summary
The provision of PHC services in Sudan is arranged across four levels of services according to the population size. Each level is provided by specific type of facilities that has standardized service profile, staffing and supported by a standardized set of management and supportive components. The four levels of service are: community services, family health units, family health centers (FHC) and local hospitals. The five core services provided through those four levels are: treatment of common illness including Integrated Management of Childhood Illnesses (IMCI), vaccination, antenatal care and family planning, growth monitoring and nutrition education and provision of essential drugs. Other PHC services e.g. management of non-communicable diseases, emergency obstetric care, mental health, dental health, eye health,are provided mainly at the level of local. Child health care services in Sudan include: Expanded
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