TY - JOUR
T1 - Addressing health system barriers to access to and use of skilled delivery services
T2 - perspectives from Ghana
AU - Ganle, John Kuumuori
AU - Fitzpatrick, Raymond
AU - Otupiri, Easmon
AU - Parker, Michael
N1 - Publisher Copyright:
Copyright © 2015 John Wiley & Sons, Ltd.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women's healthcare-seeking behaviours.
AB - Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women's healthcare-seeking behaviours.
KW - Ghana
KW - health system barriers
KW - health system responsiveness
KW - maternal health
KW - skilled delivery
UR - http://www.scopus.com/inward/record.url?scp=84994817348&partnerID=8YFLogxK
U2 - 10.1002/hpm.2291
DO - 10.1002/hpm.2291
M3 - Article
C2 - 25824650
AN - SCOPUS:84994817348
SN - 0749-6753
VL - 31
SP - e235-e253
JO - International Journal of Health Planning and Management
JF - International Journal of Health Planning and Management
IS - 4
ER -