In rural areas of Zambia primary health care is provided by rural health centres (RHCs). However, accessibility to these services is limited. In the catchment areas of two RHCs in Mazabuka district (Chivuna and Magoye RHCs) we investigated factors that caretakers perceived as barriers to health care for under five children and how they cope with the barriers. Ten Focus Group Discussions (FGDs) with caretakers of children under-five years of age and key informant interviews with six health workers from the two RHCs, and eight community health workers were conducted in May 2006. The major factors perceived as barriers were poor quality of health services, unavailability of medicines, financial constraints, weak outreach programmes, bad scheduling of health programmes, poor communication, long distance to RHCs and low awareness levels of the importance of taking children for child health week among caretakers. Caretakers’ main coping strategy was the use of the folk sector of health care. The findings of this study highlight the challenges that exist in accessing of health care in resource-poor settings and underscore that the provision of health care services of good quality remains a major challenge. 1. Introduction Access to health care for children aged below five years (under-five children) is a major public health and development issue. Even the most powerful diagnostic tests, drugs, and vaccines have little public health impact if they do not reach the people that need them the most [1]. Five dimensions of access influence the course of action of the health seeking process: availability, accessibility, affordability, adequacy, and acceptability [2]. Rural populations are especially vulnerable for a number of reasons. Problems of accessibility, including distance, long travel times to the health facilities, scarce public transport, and lack of bicycles, remain key barriers to access in many rural areas. Facilities are less likely to have well trained staff or be stocked with appropriate drugs and equipment than facilities located in urban communities [1]. Low levels of education, and cultural barriers may likewise make health information or other health-related Information, Education and Communication (IEC) inaccessible [3–5]. Issues related to affordability are major obstacles. Even where health services are available, the cost of seeking care (such as user fees, transport, and opportunity costs) may delay or prevent poor households from accessing the services [6]. In Zambia, for instance, user fees for health care in public facilities were
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