Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

Satisfaction with services was difficult to assess, especially in settings where the features of ‘goodquality’ services have not been articulated [40]. The range of studies on HIV were not reviewed.On the theoretical side, research into health care seeking has been criticised as being a “somewhatover-utilised and under-theorised tool” [42]. Despite this there is an abundance of models andapproaches on which to draw. Some authors [40, 41] have called for caution, noting the tendency formodels to focus too heavily on individual level characteristics in explaining behaviour, rather thanconsidering the broader picture. Hausmann-Mueler et al. [43] suggest that behind many models is anassumption that individuals make rational decisions to maximise utility and do not take into accountemotional aspects, the symbolic value of actions, political forces, or social and cultural relations. Keyfactors identified are often considered in isolation from the context in which they occur, even forsimple but important issues such as perception of severity of malaria being worse in some seasons.Similarly, MacKian [42] argues that to understand health seeking it is necessary to go beyond theindividual and explore further the way the “local dynamics of communities” influence the process.This requires addressing two often neglected issues: the collective element of health seekingbehaviour, and the interaction between individual and societies and health systems. The HCSBS drewon these ideas, together with a broad conceptual model developed by Kroeger, cited in [43], whichhas influenced several studies in other developing countries.2.2 – Timor-Leste studies and reportsA range of development partners in Timor-Leste, including NGOs and UN agencies, provided reportson research they had done around health care seeking. In some geographical areas there has beenextensive work focusing on specific health topics, such as child health practices, reproductive healthand nutrition. Both HAI and TAIS, for example, have produced very detailed reports that shed lighton health beliefs and practices related to maternal and child health, while UNFPA has conducted asituation analysis and qualitative research on reproductive health. In this section, we summariseonly those studies that report on health care seeking in general. 2Timor-Leste Health Care Seeking Behaviour Study | 200917The 2003 DHS included several aspects of health-seeking behaviour, summarised by TAIS [19].Approximately 1 in 10 households reported not using any health care provider when a householdmember was ill. Curative health care encounters occurred predominantly in community healthcentres (58.9%), about a quarter (24.6%) occurred in government hospitals, and 11.4% occurred inprivate clinics. Some people bypassed their community health centre and sought care at the nearesthospital instead. Mean travel time to the usual first health care provider was 35 minutes, with travelmostly by walking. Ever-married women who reported “big problems” in accessing health care forthemselves identified the following difficulties: distance to health facility (63.6%), having to taketransport (62.2%), not wanting to go alone (61.7%), getting money for treatment (59.3%), knowingwhere to go (26.7%), getting permission to go (17.9%), and concern about the absence of a femaleprovider (4.4%). One or more of these specified reasons was reported by 75.9% of respondents.In 2005 the World Bank funded a qualitative study [7] that incorporated focus groups with healthservice workers and users, and in-depth individual interviews, across 5 sub-districts. The studyexplored health care seeking behaviour, barriers to service utilisation and human resource issues.The major barriers to utilisation were found to be socio-cultural knowledge and practices, servicequality issues and geographical distance. In addition, it was found that systems of ethnomedicine2 A summary of all Timor-Leste information on health care seeking collected (research findings and personal andorganisational insights) is available on request.