Access to health services by street children in Lira Municipality, Lira District, Uganda

Abstract

This study investigated the factors facilitating and hindering healthcare access for street children in Lira municipality. The general objective was to assess the access to and utilization of health services by street children in Lira Municipality, with specific objectives focusing on the percentage of children accessing services, the barriers they face, and their perceptions towards sickness. The research adopted a convergent mixed-methods design, simultaneously collecting quantitative and qualitative data. The study applied both quantitative and qualitative approaches, utilizing a cross-sectional design which provides information collected at a single point in time in short period(Adana Şehir Eğitim ve Araştırma Hastanesi, 2024). In addition, the study used a case study design with in-depth interviews for qualitative insights. The study population consisted of full-time street children aged 10-17 years. The quantitative component comprised a purposively determined sample of 52 street children, while the qualitative sample included 4 street children (2 male, 2 female), and 4 key informants who included healthcare providers, social workers, and other stakeholders. In line with the study's objectives, the findings revealed that only 37% of street children accessed health services when sick, indicating a substantial gap between awareness of available services and their actual utilization. This low rate of service seeking is compounded by consistently low satisfaction levels due to repeated negative experiences and perceived discrimination from healthcare providers. The study identified several key barriers to accessing care, including pervasive stigma, fear of arrest, a lack of social support, hidden costs associated with "free" services, and general community rejection. Furthermore, exploring their perspectives, the findings show that street children often view illness as a major disruption to their daily survival and frequently resort to self-medication, highlighting a deep-seated lack of trust and reliance on formal healthcare systems. Given these findings, it is recommended that healthcare workers should undergo continuous training to build empathy and reduce stigma. Setting up mobile clinics and outreach services, along with implementing child-friendly, non-discriminatory policies, will help create a more welcoming environment. Strengthening support systems such as patient navigators and ensuring consistent drug availability are also crucial. Additionally, integrating health services with social protection programs and running targeted community awareness campaigns can shift perceptions, build trust, and encourage street children to seek care.