Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study

Abstract

Background: In Cape Town, the under-5 mortality rate has plateaued to 20 per 1000 live births, with 60% of child deaths occurring out of  hospital. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths. This study aimed  to uncover the access barriers and facilitators underlying this high burden of out-of-hospital deaths.

Methods: An exploratory mixed-methods case study design employed three data collection strategies: a quantitative survey with  randomly sampled community members, semistructured interviews with purposively sampled caregivers whose children presented  critically ill or deceased (January 2017 – December 2020) and a nominal group technique (NGT) to build solution-oriented consensus  among purposively sampled health workers, representing different levels of care in the local health system.

Results: A total of 62  community members were surveyed, 11 semi-structured caregiver interviews were conducted, and 11 health workers participated in the  NGT. Community members (74%) experienced barriers in accessing care. Knowledge of basic home care for common conditions was  limited. Thematic analysis of interviews showed affordability, acceptability, and access, household and facility factor barriers. The NGT  suggested improvement in community-based services, transport access and lengthening service hours would facilitate access.  

Conclusion: While multiple barriers to accessing care were identified, facilitators addressing these barriers were explored. Healthcare  planners should examine the barriers within their geographic areas of responsibility to reduce  child deaths.

Contribution: This study  uncovers community perspectives on childhood out-of-hospital deaths and makes consensus-based recommendations for improvement.