Elsevier

Health Policy

Volume 68, Issue 1, April 2004, Pages 37-46
Health Policy

Equality or equity in health care access: a qualitative study of doctors’ explanations to a longer doctor’s delay among female TB patients in Vietnam

https://doi.org/10.1016/j.healthpol.2003.07.010Get rights and content

Abstract

Earlier studies from Vietnam have highlighted the importance of studying gender aspects of health-seeking and diagnosis of potential tuberculosis patients. A longer doctor’s delay to diagnosis among female TB patients has been shown. The objective of the present study was to explore doctors’ views about and explanations for the longer doctor’s delay. Five focus group discussions and three in-depth interviews were performed in a rural province in Vietnam. Thematic content analysis was used to interpret the data. The doctors suggest that women are lost or delayed within the health care-seeking chain, mainly because of barriers associated with the female gender. These barriers are identified, but yet the patient–doctor encounter seems to be steered by an equality principle. This results in gender blindness since equal treatment is suggested despite needs being different. We argue that gender equity should be the guiding principle for the tuberculosis patient–doctor encounter. An equity principle emphasises that needs vary with factors like gender or context. We suggest more research into the health care-seeking chain in order to identify the specific steps where TB diagnosis of men and women may be delayed. Interventions are needed in order to reduce delay to TB diagnosis especially for women and the current TB control strategy, (DOTS), needs to be examined from an equity perspective.

Section snippets

Background

Vietnam is one of the high-burden TB countries in the world. During 2000, the notification rate of all TB cases was 115/100,000 [1]. Similar to case notifications from most low-income countries about two-thirds of the reported new cases in Vietnam are male and one third female. The National TB programme (NTP) in Vietnam reports 80% case detection and 92% cure rate of new smear-positive cases [1]. However, still problems remain, the notification rates have increased during the last 10 years.

Methods

The principal investigator is a Swedish medical doctor (AT) involved in international public health research, with experience from earlier studies of TB in Vietnam. The co-investigator (EJ) has thorough experience of qualitative research in low-income countries, especially in Vietnam. Both researchers have participated in the study design, data collection and analysis.

Gender and structural factors, implications for health care

In all our interviews and FGDs gender in relation to TB was never discussed in isolation. Inevitably, poverty and socio-economic inequities were mentioned at the same time.

Where resources are scarce, the allocation of funding for women’s illnesses is even less than the small amount available for men. In rural areas in Vietnam, married women often live with their husband’s family, the in-laws. The wife’s status in the family is inferior to both that of her husband and the in-laws. The following

Discussion

The Communist party in Vietnam promotes gender equality. Positive effects of the equal opportunity politics are seen in many areas [15]. Recently, a discussion of equity versus equality has emerged in the public health area. Where gender equality indicates identical treatment or opportunities gender equity implies instead a differentiated treatment when it is needed. An equity principle is thus ruled by the different needs men and women may have in a certain context. Within public health, where

Conclusions

In this study, we took a special interest in the longer time from first contact with a doctor to tuberculosis diagnosis found among female TB patients. Despite the fact that this delay has been quantitatively assessed very little is known about underlying reasons [9], [20]. Our study contributes with an exploration of this subject from the doctors’ perspective.

The delays have to be further examined and we suggest more research into the health care-seeking chain in order to identify the specific

References (21)

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