Abstract
BackgroundIn Vietnam, primary government health services are now accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. However, little is known about EMGs' own perspectives on illness treatment and use of health services. This study investigates treatment seeking strategies for child diarrhoea among ethnic minority caregivers in Northern Vietnam in order to suggest improvements to health services for EMGs and other vulnerable groups.MethodsThe study obtained qualitative data from eight months of field work among four EMGs in lowland and highland villages in the Northern Lao Cai province. Triangulation of methods included in-depth interviews with 43 caregivers of pre-school children (six years and below) who had a case of diarrhoea during the past month, three focus group discussions (FGDs) with men, and two weeks of observations at two Communal Health Stations (CHGs). Data was content-analyzed by ordering data into empirically and theoretically inspired themes and sub-categories assisted by the software NVivo8.ResultsThis study identified several obstacles for EMG caregivers seeking health services, including: gender roles, long travelling distances for highland villagers, concerns about the indirect costs of treatment and a reluctance to use government health facilities due to feelings of being treated disrespectfully by health staff. However, ethnic minority caregivers all recognized the danger signs of child diarrhoea and actively sought simultaneous treatment in different health care systems and home-based care. Treatments were selected by matching the perceived cause and severity of the disease with the 'compatibility' of different treatments to the child.ConclusionsIn order to improve EMGs' use of government health services it is necessary to improve the communication skills of health staff and to acknowledge both EMGs' explanatory disease models and the significant socio-economic constraints they experience. Broader health promotion programs should address the significant gender roles preventing highland mothers from seeking health services and include family elders and fathers in future health promotion programs. Encouraging existing child health care practices, including continued breastfeeding during illness and the use of home-made rehydration solutions, also present important opportunities for future child health promotion.
Highlights
In Vietnam, primary government health services are accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas
This study explores treatment seeking strategies among ethnic minority caregivers of children with diarrhoea in Northern Vietnam, in order to suggest improved health services for EMGs and other vulnerable groups in Vietnam
The two cases show that the non-professional ‘popular medical sector’ constituted by health care taking place within the spheres of family and community [27], plays a crucial role in the treatment of sick children among ethnic minorities of northern Vietnam
Summary
In Vietnam, primary government health services are accessible for the whole population including ethnic minority groups (EMGs) living in rural and mountainous areas. Most (97%) villages in the Northern regions of Vietnam have active Village Health Worker (VHWs) [2], who form a crucial part of the PHC system. They are laymen with short-course training in health and human diseases, typically three months of training plus occasional upgrade courses. Private health providers are a crucial part of the wider health system in Vietnam including a large numbers of traditional medical and herbal experts, spiritualists, and private bio-medical practitioners [4]. It has become normal practice among Vietnamese to purchase and self-medicate with over-the-counter drugs, many sold without prescriptions, from the large number of private drugstores and pharmacies [5,6,7]
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