Strengthening weak healthcare systems for maternal and neonatal care in low and middle income countries: Themissing link

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 sys- tems that informed this study. This paper examines how user-side and insti- tutional factors influence access and use of Maternal and Newborn Health- care (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 Ma- tayos-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 se- lected through stratified systematic random sampling for the survey. Purpo- sive sampling was used to select postpartum women, conventional and tradi- tional health care providers for 16 in-depth interviews and 7 focus group dis- cussions. Data were analyzed using descriptive and inferential statistics. Qua- litative 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 -7 th ) order deliveries occurred at home with traditional birth attendants. The choice of place of de- livery in households was influenced by spouses to respondents and commun- ities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed sys- tem-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7th pillar for user-community engagement was ab- sent. 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.