Who is to blame? Perspectives of caregivers on barriers to accessing healthcare for the under-fives in Butere District, Western Kenya

Exit interviews were conducted among caregivers seeking healthcare for their children in mid 2007 in all the 6 public health facilities. Additionally, views from caregivers in the community, health workers and district health managers were sought through focus group discussions (FGDs) and key informant interviews (KIs).Three hundred and ninety-seven respondents were surveyed in exit interviews while 45 respondents participated in FGDs and KIs. Some practices by caregivers including early onset of child bearing, early supplementation, and utilization of traditional healers were thought to increase the risk of mortality and morbidity, although reported rates of mosquito net utilization and immunization coverage were high. The healthcare system posed barriers to access of healthcare for the under fives, through long waiting time, lack of drugs and poor services, incompetence and perceived poor attitudes of the health workers. FGDs also revealed wide-spread concerns and misconceptions about health care among the caregivers.Caregivers' actions were thought to influence children's progression to illness or health while the healthcare delivery system posed recurrent barriers to the accessing of healthcare for the under-fives. Actions on both fronts are necessary to reduce childhood mortality.About 20 million children die every year, often from preventable causes such as acute respiratory tract infections, diarrhoea, measles, malaria and malnutrition [1,2]. Despite decades of impressive gains in the reduction of childhood mortality, many African nations have started to experience a reversal of these gains [1], sending fears among health experts that the fourth Millennium Development Goal (MDG) which aims to reduce childhood mortality by two-thirds by the year 2015 [3], may not be realized. Kenya has actually seen a reduction in the under five child mortality from 115 per 1000 live births in 2003 [4], to 74 per 1000 in 2008/9 [5]. Yet mortality remains well above the target