Access to health care: a case of hiv/aids orphans and vulnerable children (OVCs) in a Nairobi city informal settlement
Introduction and background Access to health care is all about receiving support and treatment, the links between treatment and prevention and how they can combine to reduce the impact of infections; and the barriers to receiving treatment. Children who have been orphaned by H1V/A1DS may not receive the health care they need. This is sometimes because it’s assumed that they are infected with HIV and their illnesses are untreatable. However, most AIDS orphans are not HIV infected l2. Research by UNAIDS shows that about 2/3 of children born to HIV positive parents do not contract the infection 58. Thus HIV/AIDS orphans are at a greater risk of dying of preventable infections because of the mistaken belief that when they become ill, it must be due to HIV/AIDS and, therefore, no point in seeking medical care. Study objectives The study examines the effects of HIV/AIDS on orphans and vulnerable childrens’ (OVCs) access to health care. It identifies health care determinants and challenges to health, including morbidity pattern, perceived quality of health care support and health-promotion within OVCs. Methodology: A descriptive cross-sectional study design consisting of judgmental/purposive sampling was used to select the study locations. The study population was OVC’s parent/s, family caregivers/guardians and community key informants. A household with a child less than 15 years of age orphaned or made vulnerable by HIV/AIDS or a related illness was the sampling unit whereas the sampling frame included all households with children less than 15 years of age orphaned or made vulnerable by HIV/AIDS or related diseases in Kibera division. Sample size was determined using Dobson’s formula for descriptive studies. Data was collected using both quantitative and qualitative techniques. Quantitative data was analyzed using SPSS computer package whereas qualitative data was analyzed thematically in line with the study objectives and the summary so obtained incorporated into validating the results of data analyzed quantitatively. Results: Out of the 399 respondents interviewed, 46.4% were males while 53.6% were females. The results indicate that surviving OVC parents headed 37.6% of the households whereas the rest had a close relative as the head. The mean age of the head of household was 34.7 years. The results indicate that malaria was the most common illness that affected the OVCs. The most preferred choice of treatment was buying over-the-counter medications. Lack of funds was the main reason for the delay in seeking medical help. Of the OVCs attended to by allopathic care providers in health facility settings, 32.6% of them ended up being admitted in various health institutions. Approximately 21% of the admissions had their bills waived by the respective institutions whereas another 4.6% absconded due to inability to pay. About 52% of the guardians spend between Ksh. 1-249 on medication for a sick OVC while 17.2%, 8.4% and 22.6% spent between Ksh. 250-499, 500-749 and more than 750 respectively per OVC per single disease episode. About 11% of the household’s gross income was spend on medical costs per every OVC who fell sick within a month. The OVC-guardian perception of what constituted quality health care included presence of well trained personnel, regular supply of drugs and other utilities, appropriate and functional diagnostic equipment, positive staff attitudes and affordable services. These aspects varied for each health care facility considered in this study. Conclusions: The majority causes of morbidity in the study area are due to diseases and conditions that are preventable through observing basic hygiene and environmental manipulation. Malaria was cited as being the most common illness that affects OVCs in the area. Other common illnesses as perceived by the respondents included respiratory conditions, gastro-enteritis including worm infestation, typhoid fever and malnutrition. Access to quality health services for OVCs in Kibera is only universal in principle but in practice, these services are not fully accessible or are of insufficient quality. For example, there is high probability of misdiagnosis of diseases by the respondents. Although malaria was cited as the most common illness that affected the OVCs, more needs to be done to ascertain the diagnosis. This is because in most of the times treatment was based on the assumption that every time a child had fever, it must have been due to malaria. Secondly, from FGDs and key informant interviews, medically unprofessional people operated most of the private health institutions. With the majority of the OVCs buying drugs over the counter, drug-resistance may increase due to irrational use of the drugs as well. With more than a third of the heads of households living below the poverty line (less than one dollar a day) and only 5.1% having gross household income of Ksh. 9,000 and above, poverty remains a serious problem in Kibera leading to inability to afford quality health care services. The findings also indicate that quality of health care in the publicly funded health care institutions was below the guardians’ expectations. Poor quality of health care was demonstrated by shortage of drugs, inadequate personnel and lack of diagnostic equipment among others. The results further revealed that availability of and physical accessibility to health care outlets not obstacles to health care. This is because of the area’s proximity to Kenyatta National Hospital and Mbagathi District hospital. Policy recommendations There is need to address the material needs of AIDS-affected households, whether in form of income-generating activities/projects, vocational training, food, clothing or school fees. HIVpositive parents and guardians are very vocal about the need for material support to provide for their many dependants. There is also need to promote and improve the provision of quality health care to OVCs at an affordable cost. It is important to introduce a social insurance scheme whose premium regimen can be affordable by low income households. The government through the ministry of health should ensure adequate supply of drugs, more trained personnel and diagnostic equipment such as laboratories and x-ray machines in order to enhance access to treatment for OVCs. Government officers from the relevant fields should also increase their surveillance in getting rid of quacks in Kibera who go about dishing out drugs to unsuspecting clients with full disregard of the ethics of medical practice in Kenya. Further, the government should explore the role of alternative health care providers.
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