Table 5 Major findings and their impact on abilities and attributes of framework to access by Levesque et al
Findings | Community | Health System | Impact |
|---|---|---|---|
Marginalisation of culture and traditions | • Deprived them of use of first line home remedies • Beliefs around birthing on country, death rituals etc. had impact on access to healthcare | • Dismissed culture and traditions as mere superstitions • Was unsure of how to handle or integrate it into healthcare delivery | Abilities • To perceive, to seek Attributes • Acceptability |
Lack of community involvement | • None of the village chiefs consulted on service delivery mechanisms • In stark contrast to traditional decision-making mechanisms in the community | • Consultation was more symbolic • Involvement of village chiefs and elders more to ensure compliance to programmes | Abilities • To perceive, engage Attributes • Approachability, engagement |
Centralisation of healthcare services | • Led to spatial exclusion and isolation of community from facilities • Delayed care seeking • Compromised quality of care | • Promoted centralisation on the premise of providing better care | Abilities • reach Attributes • Availability |
Forced compliance | • Resented forced compliance to programmes and directives • Lead to fear and lack of trust in the health system | • Pointed out this was used as last resort for the benefit of the community | Abilities • To engage, to seek Attributes • Acceptability |
Stigma and Discrimination | • Reported universally by Indigenous community • Larger approach by everyone including health system • Unconscious bias which was picked up by community • Led to lack of ownership about health system and impacted trust | • Non-Indigenous health personnel denied any stigmatising attitudes or practise • Indigenous healthcare providers confirmed that differential treatment and attitudes were a reality | Abilities • To seek, to engage Attributes • Acceptability |
Addressing the broader determinants of health | • Raised the importance of land and access to larger social determinants | • Some awareness of the impact but pointed out most of the action required was out of the mandate of the health system | Not addressed by Levesque et al. but emerged as important in the context of the Indigenous communities. |
Financial protection | • Aware of free healthcare including referrals • Aware of reimbursements of indirect expenses and other schemes | • Implemented a complete financial protection package to take care of both direct and indirect costs | Abilities • To pay Attributes • Affordability |