Getting women to hospital is not enough: A qualitative study of access to emergency obstetric care in Bangladesh

Authors: Pitchforth, E., Van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: Quality and Safety in Health Care

Volume: 15

Issue: 3

Pages: 214-219

ISSN: 1475-3898

DOI: 10.1136/qshc.2005.017285

Abstract:

Objective: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. Design: Mixed methods qualitative study. Setting: Large government medical college hospital in Bangladesh. Sample: Providers and users of EmOC. Methods: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their careers. Results: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal "poor fund" system to help the poorest women. There was no formal assessment of poverty; rather, doctors made "adjudications" of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a "wait and see" policy that meant women's condition could deteriorate before help was provided. Conclusions: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

http://eprints.bournemouth.ac.uk/10153/

Source: Scopus

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh.

Authors: Pitchforth, E., van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: Qual Saf Health Care

Volume: 15

Issue: 3

Pages: 214-219

eISSN: 1475-3901

DOI: 10.1136/qshc.2005.017285

Abstract:

OBJECTIVE: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms. DESIGN: Mixed methods qualitative study. SETTING: Large government medical college hospital in Bangladesh. SAMPLE: Providers and users of EmOC. METHODS: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers. RESULTS: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal "poor fund" system to help the poorest women. There was no formal assessment of poverty; rather, doctors made "adjudications" of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a "wait and see" policy that meant women's condition could deteriorate before help was provided. CONCLUSIONS: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

http://eprints.bournemouth.ac.uk/10153/

Source: PubMed

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

Authors: Pitchforth, E., van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: QUALITY & SAFETY IN HEALTH CARE

Volume: 15

Issue: 3

Pages: 214-219

ISSN: 1475-3898

DOI: 10.1136/qshc.2005.017285

http://eprints.bournemouth.ac.uk/10153/

Source: Web of Science (Lite)

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

Authors: Pitchforth, E., van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: Quality & Safety in Health Care

Volume: 15

Pages: 214-219

ISSN: 1470-7934

DOI: 10.1136/qshc.2005.017285

Abstract:

Objective: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms.

Design: Mixed methods qualitative study.

Setting: Large government medical college hospital in Bangladesh.

Sample: Providers and users of EmOC.

Methods: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers.

Results: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal ‘‘poor fund’’ system to help the poorest women.

There was no formal assessment of poverty; rather, doctors made ‘‘adjudications’’ of women’s need for support based on severity of condition and presence of friends and relatives. Limited resources led to a ‘‘wait and see’’ policy that meant women’s condition could deteriorate before help was provided.

Conclusions: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment.

Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

http://eprints.bournemouth.ac.uk/10153/

http://qshc.bmj.com/cgi/reprint/15/3/214?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=pitchforth&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Source: Manual

Preferred by: Edwin van Teijlingen

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh.

Authors: Pitchforth, E., van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: Quality & safety in health care

Volume: 15

Issue: 3

Pages: 214-219

eISSN: 1475-3901

ISSN: 1475-3898

DOI: 10.1136/qshc.2005.017285

Abstract:

Objective

To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms.

Design

Mixed methods qualitative study.

Setting

Large government medical college hospital in Bangladesh.

Sample

Providers and users of EmOC.

Methods

Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers.

Results

Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal "poor fund" system to help the poorest women. There was no formal assessment of poverty; rather, doctors made "adjudications" of women's need for support based on severity of condition and presence of friends and relatives. Limited resources led to a "wait and see" policy that meant women's condition could deteriorate before help was provided.

Conclusions

Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment. Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

http://eprints.bournemouth.ac.uk/10153/

Source: Europe PubMed Central

Getting women to hospital is not enough: a qualitative study of access to emergency obstetric care in Bangladesh

Authors: Pitchforth, E., van Teijlingen, E., Graham, W., Dixon-Woods, M. and Chowdhury, M.

Journal: Quality & Safety in Health Care

Volume: 15

Pages: 214-219

Abstract:

Objective: To explore what happened to poor women in Bangladesh once they reached a hospital providing comprehensive emergency obstetric care (EmOC) and to identify support mechanisms.

Design: Mixed methods qualitative study.

Setting: Large government medical college hospital in Bangladesh.

Sample: Providers and users of EmOC.

Methods: Ethnographic observation in obstetrics unit including interviews with staff and women using the unit and their carers.

Results: Women had to mobilise significant financial and social resources to fund out of pocket expenses. Poorer women faced greater challenges in receiving treatment as relatives were less able to raise the necessary cash. The official financial support mechanism was bureaucratic and largely unsuitable in emergency situations. Doctors operated a less formal ‘‘poor fund’’ system to help the poorest women.

There was no formal assessment of poverty; rather, doctors made ‘‘adjudications’’ of women’s need for support based on severity of condition and presence of friends and relatives. Limited resources led to a ‘‘wait and see’’ policy that meant women’s condition could deteriorate before help was provided.

Conclusions: Greater consideration must be given to what happens at health facilities to ensure that (1) using EmOC does not further impoverish families; and (2) the ability to pay does not influence treatment.

Developing alternative finance mechanisms to reduce the burden of out of pocket expenses is crucial but challenging. Increased investment in EmOC must be accompanied by an increased focus on equity.

http://eprints.bournemouth.ac.uk/10153/

http://qshc.bmj.com/cgi/reprint/15/3/214?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=pitchforth&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Source: BURO EPrints