Health care service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa : a care giver's perspective.
Bukenge, James Lukobeke.
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Background: Access to health care for refugees remains a challenge because of the various personal and health system obstacles they may face i.e. language barriers, poverty, negative attitudes of health care providers and their lack of understanding of the legal status of refugees in South Africa. Psycho-social and economic factors impact negatively on refugees’ general health status including their children (new born and young children). Children’s health vulnerability includes preventable and treatable conditions such as malnutrition and infectious diseases, and conditions related to their experiences of threat to safety, violence and accompanied uncertainties followed fleeing to and settling in the new host country. These children have a greater health and wellbeing vulnerability than the average child. Little information is available about the challenges that refugee care-givers experience regarding child health care services in South Africa. Objectives: The main aim of this study was to investigate refugee caregivers’ perceptions of their children’s health care problems and challenges regarding accessibility and quality of health service delivery to their young children. Methods: This study used an explanatory mixed method design in which a quantitative cross-sectional survey was followed with a small qualitative study to enable a deeper understanding of the quantitative responses. The approach therefore allowed for the examination of the prevalence of health problems reported by caregivers, and exploration of caregiver’s experiences when seeking health care for their children. The research instrument assessed some background information i.e. socio-demographic characteristics, sources of social support and perceived health status of refugee children and perceptions and experiences with health care services. Frequencies were calculated, Chi-square (χ2) test were used to explore the factors associated with refugees’ satisfaction of health care provided as well as non-parametric tests i.e. Mann-Whitney U Tests and Kruskal-Wallis tests to assess the median scores on the satisfaction with health care clinics and private doctors measures for different demographic groups i.e. gender, level of education and English proficiency as well as household resources. Thematic analysis were used for the open ended questions Results: The majority (89%) of the caregivers were women with over 70% of them between 30-35 years. The majority (80%) of the caregivers were married, 65% of them had 3 to 4 children and over two-thirds (74%) reported to have problems in communicating in English. Most caregivers (74%) visit public clinics for their children’s health care needs because it was free of charge (79%) as they were not able to afford private health care (17%). However, over 95% of the participants revealed that most of the health care workers were not receptive of refugees, making access to health care difficult. Satisfaction of health care service delivery was very poor as only 7% indicated to be somewhat satisfied. Despite demographic group differences the caregivers’ level of satisfaction were very similar across the different groups. Caregivers with no English language proficiency reported slightly more positive attitudes towards clinic health care services. Conclusion: The refugees seemed to have very limited household resources making general daily survival challenging. Their strong social networks and cohesion enable them to cope, but also seem to reinforce negative views about public health care service delivery. The existing xenophobia in the South African society play a role in negative perceptions regarding access to health care and their experiences of health care service delivery. Health care workers need to be made aware of their responsibility to deliver quality care not only South Africans alone, but to refugees as well. Refugee caregiver’s should be made aware that many complaints directed at health care workers might be system related and not necessarily addressed at refugees. Greater efforts should be made to foster mutual respect and greater integration.