Barriers and facilitators to use of male friendly clinical services in Quelimane, Zambézia province, Mozambique: results of a qualitative study, 2021

BACKGROUND: Programmatic data in Mozambique have shown that access to health services and chronic disease treatment outcomes are better among women than men. A National Strategy for Male Engagement in Health Care, including the provision of male-friendly services (MFS) was launched in 2018. In Quelimane, MFS were provided through male-friendly clinics, dedicated to male patients only, where predominantly male healthcare providers provided care through a one-stop model outside of normal clinic hours. This evaluation aimed to identify facilitators and barriers influencing utilization of these services.
METHODS: A qualitative study was done between February-April 2021 at three health facilities providing MFS in Quelimane. All participants were selected via convenience sampling. In-depth interviews (IDI) were conducted among male and female HIV-positive patients and their healthcare providers. Focus group discussions (FGD) were performed with male community members and male employees of two companies in Quelimane. Sessions were done in Portuguese or Chuabo (local language). All recordings were transcribed in Portuguese and coded by two independent investigators. Thematic analysis was performed.
RESULTS: Eighty-three IDI (41 male and 24 female patients, 18 healthcare providers) and five FGD (three involving community members, two involving company employees) were conducted. Barriers to uptake of MFS included: not knowing such services were available; poor health care seeking behavior; competing priorities (e.g., work responsibilities); perception that poor quality care would be received; and prolonged wait times. Healthcare providers highlighted barriers such as limited human resources, equipment (e.g., sphygmomanometers) or infrastructure (e.g., confidential space), and long distances (for patients and providers) from home to the health facility, which could compromise one's safety after dark. Among the facilitators for MFS uptake, all groups mentioned extended hours, one-stop-model, and male providers as program elements which increased patient comfort and willingness to share personal/confidential information.
CONCLUSIONS: Male friendly services are an acceptable means of offering male-centered care, especially for patients not able to visit the health facility during routine hours. Demand creation messaging is needed to improve awareness of MFS in the communities. Given the acceptance of the model, MFS could cover screening and management of infectious disease (e.g., HIV/AIDS) as well as non-communicable disease.

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