Affordability of health service-related costs.

The affordability of healthcare emerged as a prominent concern, as men with limited income felt burdened by the high costs associated with accessing essential healthcare services. The burden of out-of-pocket payments compels men to forgo health services, as they are forced to prioritize multiple familial responsibilities over their personal healthcare needs as shown in the quotes below.

“A man may be unwell together with the wife and family and because he doesn’t have money he will pay for their bill and stay unwell because of shortage of money.” (FGD 016 Kitui)

“They don’t have money to go to hospital to fully understand the problem and get a solution. In a month he can only get 500 shillings and he has so many needs like school fees for their children therefore he can’t go to hospital since he has other responsibilities. Also, many of them are scared of people knowing their situation.” (FGD 008 Bungoma)

Worth noting is the challenge of paying premiums for national health insurance schemes like National Health Insurance Fund (NHIF) particularly for men with limited resources.

“NHIF here in the rural area is a challenge because it costs 500 per month but there are people who even don’t get 200 shillings per month. So it becomes a challenge for a man to enrol his family to NHIF since they use the money to buy a tin of maize instead. Therefore, those with NHIF are few compared to those with NHIF.” (FGD 008 Bungoma)

In addition, the cost of accessing health services was more pronounced among men in lower socioeconomic groups who are mostly engaged in skilled and unskilled low-wage labour.

“Another problem that men face in this area is most of them work as jua kali (low wage skilled or unskilled labourer) so they get body pains and when one gets sick, he won’t bother to go to hospital because he knows it may be too costly so he passes by the shop and buys painkillers and treats himself.” (FGD 007 Bungoma)

Due to the high costs associated with healthcare services, some men reported resorting to self-treatment or traditional medicine, which was perceived as more viable and affordable compared to contemporary treatment options, especially when faced with competing family responsibilities or a combination of different financial challenges but ultimately, they said “for a man to go to the hospital, it was usually his last option”

“Men have challenges. They give health priority to their wives and children. It is very rare for men to seek health services at a health facility. They will instead turn to herbal treatment but for a man to go to the hospital then that would be his last option” (FGD 013 Isiolo)

“Many will come since a lot of us fall sick at home but only seek traditional medicine because there are no other alternatives. We don’t have money to go to hospitals and we are forced to seek traditional alternatives so as just to feel better … Because they think the traditional one is cheaper. A glass is 50 shillings and the same amount is for a registration book here and still they’ll need more for lab services and such. So they opt for traditional medicine instead” (FGD 008 Bungoma)

Health facility operations.

Participants expressed concerns about the operating hours of health facilities, which often conflict with their income-generating activities during the same hours, opting to forgo treatment to continue working on weekdays. Additionally, men reported experiencing long waiting times due to a large patient population and a limited number of healthcare providers.

“The one main challenge is this, and will not be afraid to speak is that we would like to ask the government to help us by making this facility to be operational even on weekends. You know weekends doesn’t spell the end for sickness. Sickness pops up anytime. So even weekends we ask for quality healthcare. I know we all have to rest but if there are more than one doctor at the hospital, let’s say 2 or 3 then they can be changing shifts. There is also a challenge of service at night. Catching malaria at night is hectic since service is very poor (FGD 006 Bungoma)

“The population here is usually very big but there is only one doctor. The patient ends up on the queue for almost 2hours which is an offence. Remember the patients still have to pay something what if it becomes free of charge and still there is only one doctor. It will be very challenging and will require one to seek an alternative. This will end up not being a free service.” (FGD 006 Bungoma)

Physical facility infrastructure.

The provision of services for different groups at single or shared service points, rather than having separate spaces, evoked feelings of discomfort among men due to the perceived lack of privacy during patient-provider consultations on sensitive issues such as sexual and reproductive health (SRH). Additionally, men cited instances where waiting rooms were in close proximity to consultation rooms, compromising confidentiality, as well as situations where they had to sit side by side with women while queuing for services.

“We wanted to say that privacy we look at it in two ways. There is that privacy of your conversation with the doctor which is good. The other privacy is in terms of the waiting room which is so close to the consultation room and squeezed such that a patient waiting on the bench can hear everything. When you leave the hospital, you will hear the news everywhere not because the doctor said so but because the next patient waiting could hear everything. The confidentiality of doctors on patients’ information is good but privacy during consultation is a challenge since the facility is squeezed. Privacy for men seeking confidential health care especially for STDs and STIs.” (FGD 005 Bungoma)

“Someone should go to the hospital but it’s always hard when you go there and find women on the queue and also, they feel embarrassed to go and be told that they have this disease, which brings stress to men.” (FGD 026 Nyeri)

Interaction with healthcare service providers.

The professionalism of healthcare workers. There were concerns about the lack of professionalism, particularly during interactions with healthcare providers. Specific issues mentioned included poor reception, harsh treatment, and the unauthorized sharing of patient information by healthcare providers.

“The staff attitude and unwillingness to serve people… .If we get nurses who do not listen to patients then all of them will stop going to that facility and seek services elsewhere…Poor reception of patients in the facility.(FGD 015 Kitui)

“Some (Healthcare providers) do not have privacy. They spread information about patients.” (FGD 012 Homabay)

A gap in men’s knowledge and familiarity with healthcare.

The lack of awareness about healthcare services, including universal health coverage (UHC), contributes to men’s limited understanding of the benefits of seeking medical care. Some men also expressed the need for general awareness programs and educational initiatives to increase knowledge about common diseases, symptoms, and the importance of early intervention.

“What I can add is that if possible UHC should do mass education for people…Because to be honest we men are very ignorant about our health…Yes and truth be told, if we even look at the time we got here, I don’t think there is a man who has come to the hospital. (FGD 028 Nyeri)

“If I can add that something that is very much needed in our area, it is education, education has to sensitize and motivate people to change, but they still have the culture or custom, especially with issues to do with hospital.” (FGD 030, West Pokot)

Gender disparities in program focus.

Men felt that the current healthcare systems have been designed around women and children with minimal program focus created around their own unique needs. This elicited feelings of “Being left out” even where UHC had been piloted to offer free services to all. They highlighted that they majorly see plenty of female services at facilities and fewer male services.

“Mostly only women’s services are available like clinics but men’s services maybe you just come, see a doctor but you don’t get medications so many people especially men no longer come to seek services here. We don’t get the right services that we would want so we go to other places…Maybe you go to a traditional doctor…/Yes. Roots because there are no medications at the facility that is why we chew roots” (FGD 013 Isiolo)

“We want the government to register men with Linda Wazee (Care for men) just like women are registered with Linda Mama (Care for women) …Just like women get services using the NHIF card we also want the government to help men get services. We are one family so men should be given free services just like women.” (FGD 018 Meru)

“I was thinking that the government should use the UHC to effectively sensitize locals about cancer and also focus on cancer that generally affects men. If you look at our notice boards, the government has been focusing more on women yet cancer is a serious disease which affects both genders. We don’t have any machines for screening cancer and we discover such diseases very late yet that is not the case with women.” (FGD 005 Bungoma)

Traditional masculine norms.

The notion of masculinity and the tendency to be stoic or tough can influence men’s healthcare-seeking behaviour forcing them to minimize their health concerns. Some men mentioned persevering through illnesses, such as malaria, without seeking medical attention because they perceive certain ailments as minor or believe that men should endure and manage their health issues independently.

“Men do a lot of work but when they can still walk, they think they don’t need to seek medical attention and when they need to go to the hospital, they may not have the means to come to the hospital. (FGD 029 Taitataveta)

“When we get malaria as men, we persevere in the house without going to hospital because we think malaria is such a small thing for us to come and pay to be treated. Most of us when we are sick, we think it’s better we die as men.” (FGD 009 Bungoma)

Socio-cultural beliefs and practices.

Traditional gender roles that are perpetuated by culture influence men’s interaction with healthcare. Some men spoke on the adherence to the belief that it is socially unacceptable for them to undress or discuss intimate issues with female healthcare providers, especially if they are younger. These traditional norms create barriers and discourage men from seeking healthcare or disclosing their health problems in an expressive and non-judgmental environment.

“Now if you come here and say that, you feel challenged because the person you are telling looks like your child…. So you feel embarrassed to remove your…or them to have a proper look so that is one problem…What I am saying, traditionally it is not good for any woman, whoever it is, for a man to undress and show her his private parts. So on that, there is a big problem. There is a big problem for the old men to give all their problems. If you find a woman, he can pretend that he is not sick and goes back” (FGD 019 Meru)

“I came to the hospital when I had leg pain. I was served well but there was a person who had an STI (Sexually Transmitted infection) and it was hard for him to explain to female healthcare workers his problem. He decided to lie that he had a headache so that he can be treated. The hospital should be gender equal so that they can help such people. I was forced to intervene but it was late and he had left” (FGD 001 Bomet)

Men expressed a fear of vulnerability that sometimes extends to sensitive issues like erectile dysfunction, and prostrate issues among others. Men may be hesitant to seek help for conditions perceived as socially sensitive, fearing judgment as this may be tied to stigmatization and shame. They mentioned that they would rather avoid talking about these issues but sometimes preferred talking to a male doctor who could potentially help.

“What I can say is that we should focus on STDs(Sexually Transmitted Diseases). Some very many men suffer from these diseases but are forced to stay at home. They are embarrassed about these diseases. (FGD 007 Bungoma)

Need for male-focused community health services such as.

Mental health support and programs. Men recognise the importance of addressing mental health issues and believe that counselling and the availability of community mental health support services could help individuals who are struggling. They emphasized on the need for the creation of inclusive spaces where they could openly discuss their mental health and emotions, challenging the historical expectation for men to deal with their emotions on their own.

“We need counselling and outreaches in the community. Recently, we heard there was someone who committed suicide. Would he have been counselled, he would have been helped.” (FGD 003 Bomet)

“Another thing is that men do not disclose those issues if they have them so I would say that they bring them counselling services so that they can be counselled” (FGD 021 Meru)

The men also recognized the connection between physical and mental health. They felt that they often face challenges and pressures at home that may impact their mental health, leading to physical health issues. They proposed provision of dedicated counselling specialists to help them address these challenges, provide support, and promote overall mental well-being.

“These problems that men have, when people grow old, they have difficulty urinating. I would also like universal health care to address that because there are some people who when they get to sixty years and above, that problem really affects them -I went to one doctor and he told me. It is like depression. It is what causes men to sometimes have difficulty with that thing… So what I would ask is that we have a counselling specialist…Yes. Because men are depressed at home, but you wouldn’t know if they are depressed and that problem gets to the body. So, when they go for that job, he gets defeated…Yeah. Because of Mental health problems.” (FGD 020 Meru)

Confidential Sexual reproductive health services. Men highlighted a need for confidential male SRH services. They mentioned the importance of private and confidential physical spaces during consultations, additionally advocating for family planning options for men, such as vasectomy, they also emphasized the need for private SRH services for both men and their partners.

“I think when the program will be rolled out, there will be enough rooms for privacy for men seeking confidential health care especially for STDs and STIs. In such rooms I will be able to talk freely to the doctor about my needs…I can say if I have an STD as a man and I have come to be treated, then there should be free treatment for men and their partners in cases of STDs.” (FGD 005 Bungoma)

“I think there should be more buildings because we don’t even have counselling room, the rooms are 2, so when a man comes with his partner there is no secrecy because everyone is listening to the discussion and some diseases are private” (FGD 029 Taita-Taveta)

Health screening services. Similar to health screening services for women such as cervical cancer screening, men expressed the need for screening services for conditions that affect them too. They recognized the impact of these conditions on men’s health and well-being, and believe that early detection and prevention through screening can help address these issues effectively. Men also expressed the importance of timely and efficient healthcare services, with shorter waiting times, to ensure that they receive quality care in a timely manner.

“Because as we speak, this is a level two facility. If you go to this dispensary, women are screened for cervical cancer yet me if am in pain down there, I have to go to Kenyatta or a level four facility. So that is a good health need for men. Campaigns should be done for non-communicable diseases and our facilities should be equipped with such things. That’s a point.” (FGD 005 Bungoma)

“I think the first service that should be prioritized is for chronic illnesses…Like diabetes, hypertension… They are really affecting men and even lead to this potency issues since they always start from somewhere. I ask on behalf of men that these chronic illnesses be given first priority…We as men are really suffering from cancer so if the government does bring this program, then they must focus on it… If men are to get quality services here then we must focus on time. He should be attended to in between 30 to 40 minutes and released to go home” (FGD 011 Homabay)

Outreach programs that meet men where they are. To feel equally supported and included in programs, men shared the need to also be served with outreach community services that are created and targeted specifically for them.

“If healthcare providers can go to men where they stay and talk to them and know what problems they have it will be good. Why do I say this is because the women are really being taken care of more than men in the community” (FGD 014 Kisumu)

Desire for gender-concordant healthcare.

Men expressed a desire for gender-concordant healthcare providers, particularly in the context of reproductive health services. Many participants acknowledged a preference for male healthcare providers when seeking care similar to what is available for women.

“There is need for a male nurse here for us men just like in police station where there is gender basic for women.” (FGD 016 Kitui)

“There should be equal male and female healthcare workers. When you come and find only women, there are some questions you can’t ask. If you find a man, it is easier for you to explain.” (FGD 003 Bomet)

Need for male-specific clinic days.

Men, just like women, face health challenges some of which may require tailored support and intervention. In the context of this study, men expressed a need to have male-specific clinic days same way women have pre-and post-natal clinic days as supported by the quote below:

“Could it be possible that we get clinic days for the men so that we can meet the doctors and explain our problems to them? We also ask a room in our hospital where we men can have a conversation with fellow men doctors and get treated from since some diseases are only for men and it is very difficult for men to explain them to female doctors”. (FGD 017 Machakos)