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 healthsystem 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.