Strategies applied by women in coping with ad-hoc demands for unauthorized user fees during pregnancy and childbirth. A focus group study from Angola.
Our aim in this study was to explore women's responses to reported ad-hoc demands for unauthorized user fees during pregnancy and childbirth in Luanda, Angola. Ten focus group discussions were conducted and data were analysed using grounded theory. Women were found to apply six strategies as they "endeavored to cope with demands for unauthorized user fees" (core category): (i) blowing the whistle, (ii) searching for comprehension, (iii) manipulating the system, (iv) bargaining, (v) extending the limits, and (vi) balancing. The system of unauthorized user fees appears to be a symptom of a deeper structural problem, which requires multifaceted and long-term interventions such as insti-tutional reforms and clear policies on accountability and transparency. Better resource availability for the MHC sector is required in order to secure adequate salaries to maternal health care providers. The fact that unethical behavior is unveiled implies that interventions also need to target the national midwifery training.
Pettersson
Karen Odberg
KO
Department of Health Sciences, Division of Social Medicine & Global Health, Lund University, Malmö, Sweden. Karen.Odberg_Pettersson@med.lu.se
Christensson
Kyllike
K
de Freitas
Engracia da Gloria Gomes
Eda G
Johansson
Eva
E
D000810:Angola; D004993:Ethics, Nursing; D005251:Fees, Medical; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000191:economics* / Q000592:standards; D017722:Hospital Charges; D006801:Humans; D008427:Maternal Health Services / Q000191:economics* / Q000592:standards; D008429:Maternal Welfare / Q000191:economics*; D008880:Midwifery / Q000592:standards*; D009035:Mothers / Q000523:psychology*; D033262:Narration; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011785:Quality Assurance, Health Care / Q000191:economics; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations; D016387:Women's Health