Data from: Opportunities to catalyze improved healthcare access in pluralistic systems: a cross-sectional study in Haiti

Introduction. Gains to ensure global healthcare access are at risk of
stalling because some old resilient challenges require new solutions. Our
objective was to identify determinants of intended versus actual
care-seeking behaviors in a pluralistic healthcare system that is reliant
on both conventional and non-conventional providers and discover
opportunities to catalyze improved healthcare access. Methods. A
cross-sectional study was conducted among households with children less
than 5 years of age in Haiti. Households were randomly sampled
geographically with stratifications for population density. Household
questionnaires with standardized cases (intentions) were compared to
self-recall of health events (behaviors). The connectedness of households
and their providers was determined by network analysis. Results. A total
of 568 households (incorporating 2900 members) and 65 providers were
enrolled. Households reported 636 health events in the prior month.
Households sought care for 35% (n=220) and treated with home remedies for
44% (n=277). The odds of seeking care increased 217% for severe events
(aOR=3.17; 95%CI 1.99-5.05; p< 0.001). The odds of seeking care
from a conventional provider increased by 37% with increasing distance
(aOR=1.37; 95%CI 1.06-1.79; p=0.016). Despite stating an intention to seek
care from conventional providers, there was a lack of congruence in
practice that favored non-conventional providers (McNemar’s Chi-squared
Test p<0.001). Care was sought from primary providers for 68%
(n=150) of cases within a three-tiered network; 25% (n=38/150) were
non-conventional. Conclusion. Addressing geographic barriers, possibly
with technology solutions, should be prioritized to meet healthcare
seeking intentions while developing approaches to connect non-conventional
providers into healthcare networks when geographic barriers cannot be
overcome.