Introduction: Preventable maternal and newborn mortalities still occur in local communities
in Kenya since access to maternal and newborn healthcare services remains a big
challenge. Barriers to access in resource-constrained settings have not been
examined adequately in literature. The World Health Organization (WHO) has 6
building blocks for strengthening healthcare systems that informed this study.
This paper examines how user-side and institutional factors influence access
and use of Maternal and Newborn Healthcare (MNH) Services in Matayos
sub-County-Busia County. Methods:A mixed
method approach, with an ethnographic inquiry and a descriptive cross-sectional
design, was adopted to assess access to MNH services in Matayos-Busia County,
Western Kenya. Postpartum women who had delivered within the previous 12 months
and health care providers in the study area were recruited as respondents. A
total of 348 postpartum women were selected through stratified systematic
random sampling for the survey. Purposive sampling was used to select
postpartum women, conventional and traditional health care providers for 16
in-depth interviews and 7 focus group discussions. Data were analyzed using
descriptive and inferential statistics. Qualitative data analysis was done
thematically. Results: Institutional delivery was low at 68% and family planning at 75% although
demand for services was high at 99%. User-side barriers to access included
shared beliefs and practices in the community; high direct transport costs from
home; and high costs for missing drugs and other supplies in hospitals. Middle
(5th-7th) order deliveries
occurred at home with traditional birth attendants. The choice of place of
delivery in households was influenced by spouses to respondents and communities
of residence where respondents lived or were married. All 6 WHO health system
building blocks were weak in Matayos sub-County and needed system-wide
strengthening
References
[1]
Ibeneme, S., Ongom, M., Ukor, N. and Okeibunor, J. (2020) Realigning Health Systems Strategies and Approaches; What Should African Countries Do to Strengthen Health Systems for the Sustainable Development Goals? Frontiers in Public Health, 8, 372. https://doi.org/10.3389/fpubh.2020.00372
[2]
Shakarishvili, G., Lansang, M.A., Mitta, V., Bornemisza, O., Blakley, M., Kley, N., Atun, R., et al. (2011) Health Systems Strengthening: A Common Classification and Framework for Investment Analysis. Health Policy and Planning, 26, 316-326. https://doi.org/10.1093/heapol/czq053
[3]
Ergo, A., Eichler, R., Koblinsky, M. and Shah, N. (2011) Strengthening Health Systems to Improve Maternal, Neonatal and Child Health Outcomes: A Framework. US Agency for Development, Maternal and Child Health Integrated Program, Washington DC.
[4]
Arah, O.A., Klazinga, N.S., Delnoij, D.M., Asbroek, A.T. and Custers, T. (2003) Conceptual Frameworks for Health Systems Performance: A Quest for Effectiveness, Quality, and Improvement. International Journal for Quality in Healthcare, 15, 377-398. https://doi.org/10.1093/intqhc/mzg049
[5]
Murray, C.J. and Frenk, J. (1999) A WHO Framework for Health System Performance Assessment: Evidence and Information for Policy. World Health Organization, Geneva.
[6]
Papanicolas, I., Woskie, L.R. and Jha, A.K. (2018) Healthcare Spending in the United States and Other High-Income Countries. JAMA, 319, 1024-1039. https://doi.org/10.1001/jama.2018.1150
[7]
McKenzie, A., Abdulwahab, A., Sokpo, E. and W Mecaskey, J. (2015) Building a Resilient Health.
[8]
Manyazewal, T. (2017) Using the World Health Organization Health System Building through Survey of Healthcare Professionals to Determine the Performance of Public Healthcare Facilities. Archives of Public Health, 75, 50. https://doi.org/10.1186/s13690-017-0221-9
[9]
Tangcharoensathien, V., Limwattananon, S., Suphanchaimat, R., Patcharanarumol, W., Sawaengdee, K. and Putthasri, W. (2013) Health Workforce Contributions to Health System Development: A Platform for Universal Health Coverage. Bulletin of the World Health Organization, 91, 874-880. https://doi.org/10.2471/BLT.13.120774
[10]
Krejcie, R.V. and Morgan, D.W. (1970) Determining Sample Size for Research Activities. Educational and Psychological Measurement, 30, 607-610. https://doi.org/10.1177/001316447003000308
[11]
Singh, P. and Yadav, R. (2000) Antenatal Care of Pregnant Women in India. Indian Journal of Community Medicine, 25, 112-117.
[12]
Kasmel, A. and Tanggaard, P. (2011) Evaluation of Changes in Individual Community-Related Empowerment in Community Health Promotion Interventions in Estonia. International Journal of Environmental Research and Public Health, 8, 1772-1791. https://doi.org/10.3390/ijerph8061772
[13]
Moody, L.E., Slocumb, E., Berg, B. and Jackson, D. (2004) Electronic Health Records Documentation in Nursing: Nurses’ Perceptions, Attitudes, and Preferences. CIN: Computers, Informatics, Nursing, 22, 337-344. https://doi.org/10.1097/00024665-200411000-00009
[14]
Kabene, S.M., Orchard, C., Howard, J.M., Soriano, M.A. and Leduc, R. (2006) The Importance of Human Resources Management in Health Care: A Global Context. Human Resources for Health, 4, 20-20. https://doi.org/10.1186/1478-4491-4-20
[15]
Okyere, E., Mwanri, L. and Ward, P. (2017) Is Task-Shifting a Solution to the Health Workers’ Shortage in Northern Ghana? PLoS ONE, 12, e0174631. https://doi.org/10.1371/journal.pone.0174631
[16]
WHO (2007) Everybody’s Business—Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action.
[17]
Noor, A.M., Zurovac, D., Hay, S.I., Ochola, S.A., Snow, R.W. and Noor, A.M. (2003) Defining Equity in Physical Access to Clinical Services Using Geographical Information Systems as Part of Malaria Planning and Monitoring in Kenya. Tropical Medicine & International Health, 8, 917-926. https://doi.org/10.1046/j.1365-3156.2003.01112.x
[18]
Dhar, R.S., Nagpal, J., Sinha, S., Bhargava, V.L., Sachdeva, A. and Bhartia, A. (2009) Direct Cost of Maternity-Care Services in South Delhi: A Community Survey. Journal of Health, Population, and Nutrition, 27, 368-378 https://doi.org/10.3329/jhpn.v27i3.3379
[19]
Tibebe, A., Amarech, G., Melesse, T., Mariam, D.H., Amandua, J. and Olutoyin, G. (2010) Examining Out of Pocket Payments for Maternal Health in Rural Ethiopia: Paradox of Free Health Care Un-Affordability. Ethiopian Journal of Health Development, 26, 251-257
[20]
Nyongesa, P., Kamaara, E., Ayanga, H.O., Mothaly, J., Akim, S.P., Ivy, S. and Lemons, J. (2020) Integrating Spiritual Care into Maternity Care at a University Teaching and Referral Hospital in Eldoret, Kenya: Challenges, Lessons and Way Forward. Health and Social Care Chaplaincy, 7, 168-215. https://doi.org/10.1558/hscc.37583
[21]
McKim, C.A. (2017) The Value of Mixed Methods Research: A Mixed Methods Study. Journal of Mixed Methods Research, 11, 202-222. https://doi.org/10.1177/1558689815607096
