2023-09-28 14:46:10 +00:00
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abstract: 'Policy analysis on why women and children in low- and middle-income
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settings are still disadvantaged by access to appropriate care despite
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Primary Health Care (PHC) programmes implementation is limited. Drawing
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on the street-level bureaucracy theory, we explored how and why
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frontline providers (FLP) actions on their own and in interaction with
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health system factors shape Ghana''s community-based PHC implementation
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to the disadvantage of women and children accessing and using health
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services. This was a qualitative study conducted in 4 communities drawn
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from rural and urban districts of the Upper West region. Data were
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collected from 8 focus group discussions with community informants, 73
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in-depth interviews with clients, 13 in-depth interviews with district
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health managers and FLP, and observations. Data were recorded,
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transcribed and coded deductively and inductively for themes with the
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aid of Nvivo 11 software. Findings showed that apart from FLP frequent
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lateness to, and absenteeism from work, that affected care seeking for
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children, their exercise of discretionary power in determining children
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who deserve care over others had ripple effects: families experienced
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financial hardships in seeking alternative care for children, and
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avoided that by managing symptoms with care provided in non-traditional
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spaces. FLP adverse behaviours were driven by weak implementation
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structures embedded in the district health systems. Basic obstetric
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facilities such as labour room, infusion stand, and beds for deliveries,
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detention and palpation were lacking prompting FLP to cope by conducting
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deliveries using a patchwork of improvised delivery methods which worked
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out to encourage unassisted home deliveries. Perceived poor conditions
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of service weakened FLP commitment to quality maternal and child care
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delivery. Findings suggest the need for strategies to induce behaviour
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change in FLP, strengthen district administrative structures, and
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improve on the supply chain and logistics system to address gaps in CHPS
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maternal and child care delivery.'
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affiliation: 'Atinga, RA (Corresponding Author), Univ Ghana, Business Sch, Dept Publ
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Adm \& Hlth Serv Management, Box LG 78, Legon, Accra, Ghana.
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Atinga, Roger A., Univ Ghana, Business Sch, Dept Publ Adm \& Hlth Serv Management,
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Box LG 78, Legon, Accra, Ghana.
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Agyepong, Irene Akua, Ghana Hlth Serv, Res \& Dev Div, POB MB-190, Greats Accra
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Region, Ghana.
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Esena, Reuben K., Univ Ghana, Sch Publ Hlth, Dept Hlth Policy Planning \& Management,
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POB LG 13, Legon, Accra, Ghana.'
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author: Atinga, Roger A. and Agyepong, Irene Akua and Esena, Reuben K.
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author-email: 'ayimbillah@yahoo.com
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iagyepong@hotmail.com
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rkesena@hotmail.com'
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author_list:
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- family: Atinga
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given: Roger A.
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- family: Agyepong
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given: Irene Akua
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- family: Esena
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given: Reuben K.
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da: '2023-09-28'
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doi: 10.1016/j.socscimed.2018.02.001
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eissn: 1873-5347
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files: []
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issn: 0277-9536
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journal: SOCIAL SCIENCE \& MEDICINE
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keywords: 'Women; Children; PHC; CHPS; Street bureaucrats; Frontline provider;
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Implementation; Ghana'
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keywords-plus: 'MIDDLE-INCOME COUNTRIES; ALMA-ATA; MATERNAL HEALTH; SCALING-UP; POLICY;
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SERVICES; DELIVERY; PROGRAM; WORKERS; REBIRTH'
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language: English
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month: MAR
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number-of-cited-references: '67'
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orcid-numbers: 'Agyepong, Irene Akua/0000-0002-0193-5882
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Atinga, Roger/0000-0001-7724-4706'
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pages: 27-34
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papis_id: d23efe5641675eed84f8b7d0ba3ef216
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ref: Atinga2018ghanascommunitybased
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times-cited: '17'
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title: 'Ghana''s community-based primary health care: Why women and children are `disadvantaged''
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by its implementation'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000431159800004
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usage-count-last-180-days: '3'
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usage-count-since-2013: '17'
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volume: '201'
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web-of-science-categories: 'Public, Environmental \& Occupational Health; Social Sciences,
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Biomedical'
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year: '2018'
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