Table 3 Reasons of hypertensive patients' failure to utilize CHCs’ services from the perspective of health staff and the patients (systemic problems)
Main theme | Category | Code | Semantic units |
|---|---|---|---|
Systemic problems | Educational obstacles | Lack of comprehensive and efficient training for employees | • No training for the newly recruited personnel who join the health system • Frivolousness of in-service training and retraining • Inefficient training sessions with high quantity and low quality • Insufficient attention to the use of new teaching methods |
Insufficient awareness about the disease | • Unawareness and inadequate knowledge of patients' family members about the disease • Lack of the necessary knowledge of some patients and their family members about secondary problems of the disease | ||
Motivational obstacles | Low staff motivation | • Lack of necessary and relevant incentives for executive staff | |
Procedural obstacles | Multiple staff activities and lack of time to care for patients | • No sufficient patient time allocation due to busy staff • High burden of referrals to the center physician and thus ignoring patients | |
Problems associated with information registration process | • Time-consuming registries and forms for recording information | ||
Heavy bureaucracy in the health system | • Long waiting lists | ||
Structural obstacles | Lack of sufficient amenities | • Disintegrated services and lack of facilities • Lack of space in CHCs and lack of adequate amenities and restrooms | |
Lack of specialized staff | • Lack of knowledgeable and experienced manpower and some staff members’ urge to work in multiple centers • Lack of a planning officer in the urban CHCs | ||
Problems associated with access to CHCs | • The long distance to CHCs and the length of time taken to reach CHCs • The physical condition of people and the difficulty of traveling from home to CHCs • Location of CHCs | ||
Managerial obstacles | Problems associated with management of CHCs | • Presence of physicians without executive background in CHCs • Short-term and provisional presence of physicians in CHCs • CHCs managers' ignorance of management of hypertension • Therapeutic view of physicians toward health services • Poor insurance supervision over the treatment process of patients |