Abstract
Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries.
Highlights
Ethnic minority groups are likely to have worse maternal and child health outcomes and more difficulty in using healthcare than the general population in Nepal [1,2,3]
To promote women’s use of healthcare, Community Health Workers (CHWs), known as Female Community Health Volunteers (FCHVs), are mobilised across Nepal [4]—a programme which has been implemented in other Low- and -Middle Income Countries (LMICs) such as India [5], Bangladesh [6], Afghanistan [7] and Uganda [8]
Some volunteers were concerned that their service users from indigenous ethnic minority groups such as Chepang and Tamang in the hill villages, and Madhesi and Muslims in Terai did not understand the importance of healthcare services and did not access them
Summary
Ethnic minority groups are likely to have worse maternal and child health outcomes and more difficulty in using healthcare than the general population in Nepal [1,2,3]. The FCHVs are praised for their contributions to improving maternal and child health [9,10,11], yet these improvements have been unequal across ethnic groups. Dalit women especially along with indigenous groups such as Chepang and Tamang in the hill regions, and Madhesi and Muslim in the Terai (flatland bordering south of India) are reported to underuse healthcare services despite their availability in local communities [1, 12, 13]. This study sets out to explore perceived barriers to accessing FCHVs’ maternal and child healthcare services among ethnic minority groups in rural Nepal. We briefly introduce the ethnic groups in Nepal and the FCHV programmes relevant to this study
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