The supply and demand perspective of barriers to and facilitators of health service utilisation by young people in Swaziland.

Abstract

Introduction – The country’s health care response system is organised in a four-tiered level to facilitate service utilisation by all those who need health services. Despite the health services being taken to the people and implementing deliberate efforts to increase health services utilisation, the utilisation of health services by young people has remained minimal. Accompanied by the high disease burden especially sexual and reproductive health related, the young people’s poor health seeking behaviour compromise their quality of life. The multiplier effect of that is the reduced chances for the country to reap the demographic dividend implied by the high numbers of young people. Aim – The aim of this study was to examine the factors that either prohibits or facilitates the use of health services by young people from the supply and demand perspective. This was achieved through identifying the supply and demand barriers and facilitators for young people service utilisation. Alongside, the different effects of supply and demand factors on the utilisation of health services by young people were to be studied. Methods - Nine focus group discussions were conducted, three with Peer Educators; three with potential service users; and three with facility outreach workers. Seven key informants were interviewed and they were drawn from government, parastatals and development partners. Ten one – on – one interviews with service providers from involved health facilities were also conducted. The data was analysed through the directed content analysis approach from the constructivist paradigm. Results – The socio-cultural beliefs, practices and norms which are facilitated through the limited community stakeholder engagement prohibits the young people from making the initial visit to the health facilities. These socio-cultural practices, beliefs and norms in the community also influence the health facility environment which in turn have a potential to exacerbate stigma and discrimination at the health facility and community level. Creating a conducive environment for stigma and discrimination at the health facility is the absence of adolescent and youth friendly health service policy and the current service delivery system employed at the health facility. The lack and presence of youth friendliness amongst service providers was identified as both a barrier and a facilitator of service utilisation by young people, respectively. Reported to be determined by age, sex and qualification of service provider, youth friendliness was also defined differently by young people and the technical and professional sector. However, distance to health facility and costs attached to service utilisation were not identified as barriers to service utilisation in this study. Conclusion – Service utilisation by young people is an interplay of the supply and demand factors where the demand factors mainly affect the initial use of the health services whilst supply factors affect the subsequent use of health services. However, not all factors are equally influential to service utilisation, some factors are more influential compared to others.