Etiaba, E, Manzano, A orcid.org/0000-0001-6277-3752, Agbawodikeizu, U et al. (6 more authors) (2020) “If you are on duty, you may be afraid to come out to attend to a person”: fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective. BMC Health Services Research, 20 (1). 903. ISSN 1472-6963
Abstract
Background
Maternal and Child Health is a global priority. Access and utilization of facility-based health services remain a challenge in low and middle-income countries. Evidence on barriers to providing and accessing services omits information on the role of security within facilities. This paper explores the role of security in the provision and use of maternal health services in primary healthcare facilities in Nigeria.
Methods
Study was carried out in Anambra state, Nigeria. Qualitative data were initially collected from 35 in-depth interviews and 24 focus groups with purposively identified key informants. Information gathered was used to build a programme theory that was tested with another round of interviews (17) and focus group (4) discussions. Data analysis and reporting were based on the Context-Mechanism-Outcome heuristic of Realist Evaluation methodology.
Results
The presence of a male security guard in the facility was the most important security factor that facilitated provision and uptake of services. Others include perimeter fencing, lighting and staff accommodation. Lack of these components constrained provision and use of services, by impacting on behaviour of staff and patients. Security concerns of facility staff who did not feel safe to let in people into unguarded facilities, mirrored those of pregnant women who did not utilize health facilities because of fear of not being let in and attended to by facility staff.
Conclusion
Health facility security should be key consideration in programme planning, to avert staff and women’s fear of crime which currently constrains provision and use of maternal healthcare at health facilities.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s). 2020. This is an open access article under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0/) |
Keywords: | Security, Safety, Primary care facility, Maternal and child health services, Providers, Users, Realist evaluation |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Nuffield Centre for International Health and Development (Leeds) |
Funding Information: | Funder Grant number MRC (Medical Research Council) MR/M01472X/1 |
Depositing User: | Symplectic Publications |
Date Deposited: | 02 Oct 2020 15:26 |
Last Modified: | 02 Oct 2020 15:26 |
Status: | Published |
Publisher: | BMC |
Identification Number: | 10.1186/s12913-020-05747-9 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:166166 |