Beneficiaries of conflict: a qualitative study of people’s trust in the private health care system in Mogadishu, Somalia

Abstract

BackgroundIn 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as “access to adequate health care for all at an affordable price”. Despite this, an estimated 90% of Somalia’s largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people’s trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country.MethodsA qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis.ResultsOur findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country’s citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging – including the widespread practice of further appointments for follow-up – which inflates the costs. The study also found poor patient–provider relationship and widespread distrust of the private health care system.ConclusionThe study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor–patient relationship has been – and remains – a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with dignity and respect. The education system, particularly the syllabus used by medical faculties, should be reviewed and improved to provide medical students with necessary knowledge, skills and attitudes to maintain patient dignity and rights.

Barriers to accessing health care services: a qualitative study of migrant construction workers in a southwestern Indian city

“…Distrust is, however, no inherent feature for only public services. Examples from Somalia suggest that also private health services can be distrusted if they are poorly organised or pressured by social instabilities [27].…”

Barriers to accessing health-care services: A qualitative study of migrant construction workers in a Southwestern Indian city

“…Distrust is, however, no inherent feature for only public services. There can be distrust also in private health services if they are poorly organised as was the case in Somalia [26].…”

Access to Norwegian healthcare system – challenges for sub-Saharan African immigrants

“…In addition, studies in Norway often grouped African immigrants with immigrants from other regions of the world, in assessing the use of healthcare services [40][41][42][43][44][45]. Meanwhile, certain factors may have a differential effect on health care utilization between population groups [8,9], especially as SSA immigrants are confronted with issues of low socio-economic status, language difficulties, coupled with having different cultural beliefs and boundless trust in traditional medicine [46][47][48][49]. In addition, this population is different in that, as "blacks", they often experienced racial discrimination in most walks of life [39,50,51] and treated as second class citizens [52].…”