Abstract

Nabukeera-Barungi Nicolette* and Stefan Peterson

Current population trends show increasing rural-urban migration, with majority living in urban slums. Studies show higher disease burden and childhood mortality in the slums than rural areas. Late reporting to hospital is the main contributor to the reported 50 to 70% of hospital deaths in the first 24 h of admission in resource limited settings. Providing a free health unit within 5 km radius of every community is assumed to bridge the access gap. We set out to describe barriers to timely health seeking behaviour among caregivers of children under- 5 years in an urban slum community with geographical access free healthcare. This qualitative research used focus group discussions and key informant interviews. Subjects were caretakers of children under- 5 years living in Makerere Kivvulu slum. Their perceived risks of death during illness, options when children get sick, preferences, determinants of their choices and barriers to health care were assessed. Our study found that the caretakers could identify the signs of serious illness which needed hospitalization. The availability of money was the main determinant of their healthcare choices. They had several options for health care but they preferred Mulago Hospital, a free national referral hospital which also serves as their first level health unit. They appreciated the quality of services and the close proximity but are overwhelmed by barriers to its utilization. These barriers included long waiting hours, bribery in the waiting lines, rudeness of the health workers, lack of drugs in these free facilities among others. Although the community in this urban slum seem to have geographical access to free medical services, financial access still remains the main barrier to its utilization. For communities which depend on a daily income, a day spent in hospital translates into financial loss.