Exploring the Barriers and Enablers of Access to Child Health Care Services in Debre Tabor, Ethiopia – A mixed methods study

Background: Access to high-quality health care has a substantial influence on the survival of under-five children. In Ethiopia, the use of health care services is notably low for childhood illnesses compared to higher-income countries, making children more vulnerable to higher risk of chronic multi-morbidity and mortality. Previous research from higher-income countries demonstrates that child morbidity and mortality is reduced when there is improved child health care access. Therefore, it is crucial to explore barriers and enablers to current health care access in Debre Tabor, Ethiopia to improve child health outcomes.  The objective of this study is to comprehensively identify the barriers and enablers to accessing child health care services and to develop co-design interventions that address these barriers and support enablers in Debre Tabor, Ethiopia. Methods: This research is guided by Levesque et al. (2013) Access to Health Care Conceptual framework that includes dimensions of Approachability, Acceptability, Availability, Accommodation, Affordability, and Appropriateness. This research is informed by critical theory and utilises a mixed-methodology approach. The research project will unfold in four phases: Phase 1 will conduct a systematic review using mixed-methodology to synthesise evidence on barriers and enablers for parents accessing child health care services in low- and middle-income countries. Phase 2 will involve a retrospective cross-sectional survey to identify patterns and demographics of hospital admissions for children under five. Phase 3 will utilise exploratory qualitative methods with health governmental decision-makers and health professionals, along with a phenomenological study involving parents. Health governmental decision-makers will be invited to participate in semi-structured key informant interviews, while health professionals will be contacted for focus group discussions. Additionally, parents will be approached for individual semi-structured interviews. Finally, phase 4, based on evidence of mixed-method integrated findings, will consist of a co-design workshop to develop interventions. Data will be analysed using descriptive analysis, thematic analysis with hermeneutic interpretation, and the Braun and Clarke approach, with themes mapped to Levesque’s Access to Health Care framework. Expected outcomes: This study will address critical gaps by identifying barriers and enablers to accessing child health care services, providing actionable insights for local and national stakeholders, including health governmental decision makers/administrators, health professionals, and parents. These insights will guide the development of co-designed interventions to improve accessibility to child health care services and enhance child health outcomes in Ethiopia, and other low and middle-income countries. Keywords: Health Services Accessibility, Parents, Child, Child Health Services, Ethiopia