Barriers in access to services and information gaps by genders and key populations in the national Tuberculosis programme in Cambodia

ABSTRACT

Approximately 34% of people with tuberculosis (TB) were undiagnosed in Cambodia in 2017. This study explored barriers in access to TB services and information gaps by genders and key populations in the Cambodian national TB programme. In 2017, we conducted a consensus and validation workshop, desk reviews, 19 in-depth interviews, and 30 focus group discussions with representatives of stakeholder groups, affected populations, and communities. Content analyses were performed for qualitative interviews. We employed the consensus development methods during the workshop to define and prioritise key populations. Key themes that inhibited access to TB services included the lack of knowledge, awareness, time and financial means, and gender-specific vulnerabilities. Systemic barriers included inconsistencies in policy and guideline implementation and lack of resources required for effective TB management. We did not find indications of coercive practices against women and key populations. However, stigma and discrimination did exist in healthcare institutions, the workplace, and the community. There were significant gaps in gender and key population-specific data and reporting systems at all levels. Data availability is vital for understanding gender and key population-specific gaps, and they should be duly utilised. Mechanisms to ensure equality and inclusivity are necessary to end TB in Cambodia.

KEYWORDS:

• Equity in health
• access to care
• infectious disease
• vulnerable population
• Asia

Acknowledgements

We acknowledge the contributions of members of the project’s Steering Committee and Technical Working Group from the National Tuberculosis Center for Tuberculosis and Leprosy Control; National Center for HIV/AIDS, Dermatology and STD; Ministry of Women’s Affairs; non-governmental organisations, the World Health Organization, UNAIDS, the United States Agency for International Development, and tuberculosis communities and key populations. We also thank Sothearith Eng, a research assistant at KHANA Center for Population Health Research for his support in transcription and translation of the qualitative data and Dr. Peter Mok, Technical Consultant from Stop TB Partnership for his excellent technical support throughout the assessments.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Dr. Siyan Yi ([email protected]) upon request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Stop TB Partnership.