TITLE:
Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link
AUTHORS:
Paul Nyongesa, Faith Yego, Philiph Tonui, Peter Itsura, Bennad Sorre, Egessah O. Omar
KEYWORDS:
WHO Building Blocks, Low and Middle-Income Countries, Maternal and Newborn Health, Strengthening Health Systems, Community Engagement Pillar
JOURNAL NAME:
Advances in Sexual Medicine,
Vol.12 No.1,
December
23,
2021
ABSTRACT: 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 involving all pillars. The user-community voice alone was
insufficient and the 7th pillar for user-community
engagement was absent. The underlying factors were weak governance and
underfunding for healthcare. Conclusion: The six WHO building blocks were inadequate due to weak governance and
inadequate funding. User-community engagement, the 7th Pillar, was absent in these resource-limited settings. We recommend
user-community empowerment, engagement and participation, adoption of a system
thinking approach and adequate funding.