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

Figure 7 - Improving access, quality and managementDeterminantsof healthseeking:• Physical• Economic• SocialUserexperiences andperceptions• Cultural healthbeliefsServices andproviders• Self-treatment• Traditional• ModernHealth careconsultationHealthSatisfactionPositiveoutcomeContinuingpoor healthor deathSatisfiedNot SatisfiedThe many dimensions of access—physical, financial and socio-cultural—all play an important part indetermining what services are used, where and when. Community members want health servicesthat are readily available, affordable, and socially and culturally acceptable. Having to transport asick person, or a pregnant woman, to distant services is costly in many ways and is a powerfuldisincentive to service utilisation. Family members have an important say in the decision to seekassistance, or accept referral to another health facility. Around issues of child birth and fertility, awoman’s in-laws may also be influential. These barriers need to be addressed, for example byimproved transport and communication (not only a matter for the health sector) and culturallysensitiveoutreach models. SISCa, which is currently being developed and extended, may contributeto improving access.Community members at the village level have clear expectations of government health services andhow they should be delivered. They expect to be treated with consideration and wantacknowledgment of the efforts they have made to seek assistance, especially if they travelled far.They expect to have the history of their condition carefully assessed and to be properly examined,with the use of relevant tests and equipment. They expect to be treated with medication, to bereferred to a larger health facility if necessary, and to be given personal advice on prevention. Theyare, however, often disappointed with one or other aspect of the services provided. Assuringconsistent delivery of good quality comprehensive services is essential to building trust in thegovernment health system.Much of the dissatisfaction experienced by users—patients and their families—was due tolimitations of the system: lack of infrastructure, equipment and drugs; lack of qualified staff; and, inplaces, restricted facility opening hours. Access to health workers out-of-hours in emergencies, suchTimor-Leste Health Care Seeking Behaviour Study | 200954