Table 4 Community Resident perceptions of private and public health providers in health facilities, community health volunteers and traditional healers, Care-Seeking Behavior Study, Madagascar, 2018
Type of care | Community resident perceptions (Positive) | Community resident perceptions (Negative) |
|---|---|---|
Public health facility/provider | •Public HPs are experienced and can provide care in case of severe diseases •Bednets are distributed free of charge ••Consultations are free | •Drugs can be expensive •Drugs, equipment, and commodities are not well managed and are frequently out of stock •Long wait times •Sometimes the number of providers is insufficient, and providers are only available in the morning •Unsatisfactory reception of patients by clinical and administrative staff, poor treatment of patients by trainees, lack of listening capacity, lack of respect for patients •Lack of confidentiality •Sometimes the facilities are poorly maintained |
Private HF/provider | •Health providers are nicer and more welcoming [than public providers] •There is little or no waiting time •Case management is of good quality and there is frequent follow up •Clinical examinations are properly performed •Pharmaceuticals are of good quality •In general, quality of care is better [than public facilities] | •There are no private facilities in some communes •Consultations and pharmaceuticals are more expensive [than public health facilities] |
Community health volunteer | •CHVs are more welcoming than clinical staff in HFs •Patients do not have to pay very much to see CHVs •Drugs are cheaper [than they are at health facilities] or free •CHVs are accessible •Community residents are used to seeing CHVs in their community | •CHVs do not generally provide care, but are more focused on giving advice and recommendations, especially for children under 5 years of age •Frequent stockouts of malaria commodities including RDTs •CHVs do not have a lot of training |
Traditional healers | •Their services cost less compared with services in the formal health system •Some CRs trust them because they treat diseases with massage and natural remedies •Proximity of traditional healers due to communities' geographical remoteness and distance from HFs •Some CRs visit them because they fear being referred to a hospital •Patients feel welcomed •Very little waiting time •Habits and customs: It is taboo to see a doctor and receive shots •Belief that there are diseases that hospitals cannot cure •The need to possess "ody" (natural medicines to cure ailments) when people lack information and awareness and tend to view diseases as evil •It is felt that formal healthcare providers sometimes discriminate against certain groups of people and traditional healers do not | •The advice is not accepted by the medical community within facilities •Some CRs regard individuals who use traditional providers as ‘seekers of witchcraft’ •Some CRs go out of habit, not necessarily because it is the best choice for care •The term ‘country people’ is given to some CRs who visit traditional care providers, implying that they are uneducated or have outdated ways of behaving |