Community-based referral transportation system for accessing emergency obstetric services in the Rohingya refugee camp during the COVID-19 pandemic in Bangladesh: facilitators and barriers through beneficiaries’ and providers’ lens using a mixed-method design

Abstract

Background Delays in seeking timely maternity care from health care professionals are crucial to address among the Rohingya population where many preventable pregnancy-related deaths occur within the camps when care is not sought. To address the challenges related to the referral of emergency and routine Sexual and Reproductive Health and Rights (SRHR) cases, United Nations Population Fund, through its partners, implemented a community-based referral transportation project called Referral hub. This paper presents the barriers and facilitators to the implementation of this referral transportation system from the perspectives of the beneficiaries and providers. Methods The research adopted a sequential explanatory mixed-method design. The quantitative phase consisted of a survey among 100 women while the qualitative phase comprised of in-depth interviews with a total of 12 mothers who used the services and key informant interviews with 21 providers. Results The barriers identified for referral hub are discordant understanding of emergency, strict gender norms and practices, distrust in providers, poor roads and mobile phone networks. The facilitators are partnership with the community, within and other organizations. Conclusion The study observed that the referral hub has a high potential to increase the utilization of SRHR services. Despite the barriers, the facilitating factors show a scope of improvement for these services.

Uptake of Reproductive, Maternal and Newborn Health in the Context of Covid-19 Pandemic in Kenya

“…Negative attitude of health care workers also contributed to clients not seeking services. Similar findings were established in other studies (11)(12). Other than lock down and restriction of movement, distance to the health facilities also contributed as a barrier to accessing reproductive health services.…”

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions

“…During COVID-19, women who are refugees and mothering are at high risk of experiencing add on stressors due to limited social support, difficulty accessing health care, and other COVID-19-related restrictions put in place in their social environment. Fear of getting sick, limited socialization, lack of social support, economic difficulties, limited follow-up community-based care, inability to access health-care settings, and restrictions on their ability to stay with their sick hospitalized child due to COVID-19 restrictions caused negative effects on mothering refugees' mental health Barua et al [ 55 ] Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh Mixed methods Secondary data of routine utilization of the 12 referral hubs through key informant interviews and a community survey conducted with 100 pregnant women To describe the implementation process of the Referral Hub (RH) and present clients’ utilization and perception of the service Refugee camps Bangladesh Persecution in Myanmar 2017 5 Refugees COVID-19 Mothers ANC The RH is a timely innovation to increase access to emergency obstetric care in the Rohingya population even during the COVID-19 pandemic. Moreover, it is a boon to the Rohingya community that otherwise lacks proper and easy access to transport facilities, especially during an emergency.…”

“…So, we noted that… all the upstream work that we do with policy guidelines… things were not moving, everything had to come to a standstill for like five months ” [ 42 ]. In LMICs, a number of women chose traditional birthing practices owing to service disruption [ 42 , 55 ]. Similarly, routine immunization programs were significantly impacted during Ebola, primarily due to widespread disengagement of the population with healthcare services, but also due to a reduction in the outreach services provided by healthcare workers in the community [ 56 ].…”

“…Additionally, care across MNCH domains was affected by constraints (e.g., poor care seeking behaviors, lack of awareness of health conditions, and lack of trust) [ 42 , 47 , 52 , 57 , 63 , 65 ]. Low utilization of services was provoked by refugee women’s health status, lack of awareness of available services, and limited knowledge of facility guidelines during the pandemic [ 47 , 55 , 65 ]. Most women experienced these challenges while in need of neonatal and childcare services, ANC, and IPC [ 45 , 51 ].…”

Perceptions and attitudes of Rohingya community stakeholders to pregnancy termination services: a qualitative study in camps of Cox’s Bazar, Bangladesh

“…Chittagonian is the indigenous dialect spoken in the regions of Cox’s Bazar where the camps are situated. Similar strategies were followed in other studies to collect data on the Rohingya population [ 45 , 46 ]. According to a language assessment conducted by the Translators without Borders, the Rohingya languages and Chittagonian dialects share 70–90% similarities [ 47 ].…”