Barriers and facilitators associated to use primary health care services for children younger than 6 years old, in sentinel sites of Costa Rica

Abstract

Objectives: to determine the barriers and facilitators why the population is using or not the services at the primary care level for the children 1-6 years of age in the communities of Damas de Desamparados, San Antonio de Nicoya and indigenous community of the Casona. Methods: A qualitative methodology was applied to fulfil the objectives. Three sources of information were used: semi- structured interviews to mothers or legal guardians, and local health care teams workers of the EBAIS, as well as direct observations (to triangulate information) in health care settings of three communities: one urban, one rural and one indigenous. Results: Reasons for using the services in the three communities are related to the benefits of the medical consultation, good attention from the health care team and the infrastructure of the health care facility. However, the reasons for not using the services are mainly a concept of health as “absence of disease”, lack of information regarding the services provided, family poverty, the no offer of a pre-scheduled appointment after one year of age which is very important and relates to an institutional norm that prioritize on children younger than one year of age.
Reasons related to the context are very important such as: long distances to the health care setting, lack or limitations for transportation, weather constraints, roads in bad condition. These reasons are particularly important in the indigenous community and rural. Conclusion: The process of assigning an appointment for growth control to children older than one year of age and younger than five years of age may be the strategy to improve coverage on those communities. A review of the capabilities and infrastructure of the EBAIS is also recommended in order to reach the needs and geographical differences of the communities, children and families with particular attention to the indigenous communities.