Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana

Abstract

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. Copyright © 2015 John Wiley & Sons, Ltd.

Disparities in Abortion Experience and Access to Safe Abortion Services in Ghana: Evidence from a Retrospective Survey

“…The survey formed part of a larger, original multi-method study that was conducted between November 2011 and May 2015 in the Bosomtwe and Central Gonja districts of Ghana to examine the effects of Ghana's user-fee exemption policy on women's maternity care seeking experience, equity of access, and barriers to accessibility and utilisation of reproductive, maternal and newborn healthcare services. A number of articles -based on both qualitative and quantitative analysis of data generated from this larger study -have already been published [14][15][16][17][18][19] . In this paper, the focus is on reporting findings from a component of the survey, which examined women's experiences of abortion as well as accessibility to safe abortion services.…”

Unmet reproductive health care needs among rural Ghanaian women

“…Stakeholders' views in Ghana on maternity care shortcomings cites poor obstetric care, informal payments, poor allocation of skilled providers and unfriendly health provider attitude as factors impeding service provision and utilization (Arthur, 2012;Atinga & Baku, 2013; Josephine Borghi et al, 2003;Perkins et al, 2009). Evidence from other studies show many barriers for maternity care seeking, which are related to providers, health system features and user characteristics (Addai, 1998;Asamoah et al, 2014;Atinga & Baku, 2013;Atunah-Jay et al, 2013; Josephine Borghi et al, 2003;Filippi et al, 2006;Ganle, 2014;Ganle et al, 2015;Lambon-Quayefio & Owoo, 2014;Perkins et al, 2009; Sophie Witter et al, 2007). Policy directives in the past decades have prioritized private health actor's role in health service delivery.…”

“…Evidence from other studies show many barriers for maternity care seeking, which are related to providers, health system features and user characteristics (Addai, 1998;Asamoah et al, 2014;Atinga & Baku, 2013;Atunah-Jay et al, 2013;Josephine Borghi et al, 2003;Filippi et al, 2006;Ganle, 2014;Ganle et al, 2015;Lambon-Quayefio & Owoo, 2014;Perkins et al, 2009;Sophie Witter et al, 2007). Policy directives in the past decades have prioritized private health actor's role in health service delivery.…”

“…Thematic policy actions, such as the health sector gender policy (2009), the reproductive health strategic plan (2007)(2008)(2009)(2010)(2011), and the fee-exemption policy for maternity care (2003), were implemented after consultative stakeholder engagements. Despite these collaborations, health system bottlenecks impact negatively on maternal service delivery and quality (Ganle et al, 2015). Top-down approaches and weak dissemination among policy stakeholders still characterize some health decisions (MOH, 2008d).…”

“…DHS findings in Ghana also show consistent increases in satisfied demands for modern contraceptive use between 1998(GSS, GHS, & ICF, 2014. Notwithstanding, barriers for women's access and utilization of reproductive and maternal health services are increasingly reported (Atinga & Baku, 2013; Josephine Borghi et al, 2003;Filippi et al, 2006;Ganle, Parker, Fitpatrick, & Otupiri, 2015;Perkins et al, 2009; Witter, General Introduction 11 Chapter 1 D. K., . Inadequate obstetric care and poor health staff-patient relations and its impacts on maternity service outcomes is evident in Ghana (Ganle et al, 2015).…”