Connecting gender and social networks to explore health service access and use in Negros Occidental, Philippines: A qualitative study

Abstract

Background: In early 2019, the Universal Health Care Bill was signed into law in the Philippines with the intention of enabling all citizens to access a comprehensive range of health care services without bearing costs. To ensure the success of this reform, it is critical to understand how individual- and structural-level factors influence health system navigation among individuals that have historically had difficulty accessing and using health care services. Among Filipina women experiencing poverty, there is limited understanding of the social, cultural, and financial factors that enable and hinder health care access and use throughout the lifespan. By understanding how gender interacts with the by-products of social networks to shape health care access among women, there is an opportunity to inform programs delivered by non-governmental organizations (NGOs) in the context of Universal Health Coverage (UHC) implementation.

Research question: The purpose of this thesis is to 1) describe health care access and use among women experiencing extreme poverty, 2) investigate how gender and social networks interacted and influence health care access among young, middle-aged, and older adult women experiencing poverty, and 3) describe how health care providers accommodate and care for populations experiencing poverty in Negros Occidental, Philippines.

Methods: This project was built on a collaboration with a Philippine-based NGO, International Cares Ministries (ICM). Semi-structured interviews were conducted with participants (n=35) and health care providers (n=15) in seven communities in Negros Occidental, Philippines. Descriptive statistical analyses were performed to report basic demographic information. A hybrid deductive-inductive thematic analysis was applied to identify and explore emerging themes. The Patient Centred Access to Health Care framework and Life Course Theory were used to guide the hybrid thematic analysis.

Results: Three main themes were identified to describe the stages that women encountered when accessing and using health care services: 1) characterizing pre-departure access factors; 2) identifying health care utilization factors; and 3) characterizing post-care health outcomes. Notably, health care access pathways varied among different age cohorts. Younger women prioritized the health of their children, and connected with their immediate families and relatives for social and financial support. Unlike other age cohorts, middle-aged and older adult women connected with governmental agencies and neighbours and had financial support from their children to cover their medical care costs. A fourth theme emerged which provided insights on how health care providers responded to the needs of their patients, and the challenges they encountered when delivering care.

Discussion and conclusion: Affordability acts as a persistent access barrier to reaching and engaging in health care services among women experiencing poverty in the Philippines. Findings indicate that women may have varying degrees of social support from their personal and external networks throughout their lifespan that can contribute to the availability of social and financial resources, which may enable or hinder their access to health care services. This information is important to consider in light of recent efforts in the Philippines and in other low- and middle-income countries to implement UHC that is equitable and gender-responsive.