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.
