Barriers to Access of Healthcare Services for Rural Women – Applying Gender Lens on TB in a Rural District of Sindh, Pakistan

Abstract

Background: Women in rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for Tuberculosis (TB). This study was conducted to assess the general understanding of TB and of access to healthcare for women, as a first step towards implementation of a gender responsive TB programme in TandoAllayar, a rural district of Pakistan. Methods: A total of 36 participants were interviewed. The focus group discussion guide comprised of questions on: (1) family/household dynamics (2) community norms (3) healthcare system (4) women’s access to healthcare (5) TB Awareness;, and (6) women’s access to TB Care. Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access of healthcare for women, higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. Conclusion: Significant barriers are faced by women in access to TB care in rural districts of Pakistan. Programme implementers in high burden countries, should shift towards improved gender-responsive TB programming.

Distance and health facility choice: Evidence from a health micro insurance program in Punjab, Pakistan

“…Moreover, women are 6.3% points more likely to be treated at the nearest hospital as compared to men 24 . One of the reasons for this might be that women's mobility is largely constrained in a low‐income setting like Pakistan since they are generally accompanied by male members of the household for transportation needs 46,47 . This can be linked to poor infrastructural support and women‐centric cultural barriers in the country such as lower societal status of women, predominance of men in the social structure and segregation among both genders 43–45 .…”

Factors Associated with Development of Ventral Hernias and Healthcare Seeking Behaviors in a Cohort of Pakistani Women

“…Myths have been an integral reason Pakistan has faced barriers to healthcare 11 and dispelling these are important for timely healthcare seeking practices and behaviours. Women may be told that their predicament is normal and all women face it and treatment is not needed, or they may be told that unless there is pain it is not problematic or in the case of one of our participants being told that an iron mesh would be placed which would surely lead to demise.…”

“…Ventral hernias are a very common presentation and there is little information or awareness that is given to them at the community level. Another barrier to health-care that we are less likely to account for is decision making capacity for the South Asian woman in a traditional set-up 10 . Women may find that even if they wish to seek healthcare they may be obstructed by unsupportive spouses who may not have the time to bring them to a hospital and will not allow them to travel unescorted or by the interference of relatives who will persuade the spouse to not seek healthcare.…”