Health workforce perspectives of barriers inhibiting the provision of quality care in Nepal and Somalia – A qualitative study

Authors: Malin Bogrena, Kerstin Erlandssonb , Anders Johanssonc , Mohamed Kalidd , Asad Abdi Igale , Jamal Mohamedf , Fatumo Saidg, Christina Pedersenb , Ulrika Byrskogb , Fatumo Osman

Sexual and Reproductive Healthcare, 2020


Objective: In this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective.

Methods: Data were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia.

Results: Various structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect,  verbal abuse, and lack of competence.

Conclusions: Inequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.

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