Incentives to yield to Obstetric Referrals in deprived areas of Amansie West district in the Ashanti Region, Ghana

Abstract

BackgroundObstetric referrals, otherwise known as maternal referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of Obstetric referral systems is however marred by the lack of accessible transportation and socio-economic disparities in access to healthcare. This study evaluated the role of socio-economic factors, perception and transport availability in honouring Obstetric referrals from remote areas to referral centres.MethodsThis was a cross-sectional study, involving 720 confirmed pregnant women randomly sampled from five (5) sub-districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured questionnaire using face-to-face interviewing and analyzed using STATA 11.0 for windows. Logistic regression models were fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals.ResultsAbout 21.7 % of the women studied honoured referral by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58 %) and lack of transport (17 %). A higher household wealth quintile increased the odds of being referred and honouring referral as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as emergencies and severe were also more likely to honour obstetric referrals (OR = 2.3; 95 % CI = 1.3, 3.9).ConclusionClients’ perceptions about severity of health condition and low income remain barriers to seeking healthcare and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Implementing social interventions could improve the situation and help attain maternal health targets in deprived areas.

Exploring the roles and factors influencing community health workers’ performance in managing and referring severe acute malnutrition cases in two subdistricts in South Africa

“…The strength and sustainability of CHW programs rely on enhancing infrastructural support through providing reliable transportation, equipment and drug supplies—key dimensions of the NHI/UHC reforms (Lehmann, Friedman, & Sanders, ). Findings from this study corroborate those from Ghana on obstetrics programs and from Swaziland on HIV/AIDS clients’ transport difficulties after referral instructions (Macintyre et al, ; Nuamah et al, ). The study context had reliable emergency ambulance services for most sites, with a few requiring expensive means that were not feasible for poor individuals.…”

Predictors of Neonatal Deaths in Ashanti Region of Ghana: A Cross-Sectional Study

“…Some simply lack confidence in the health system. Difficult geographic terrain and limited transportation may present obstacles to reaching a skilled attendant [12,13].…”

The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

“…Most studies (n=13) investigated the quality of referral from the perspective of healthcare providers either through interviews or audit of health facility records [1,8,[29][30][31][32][33][34][35][36][37][38][39]. Two studies explored women's experiences of maternal and newborn referral [40,41]. One study included both healthcare providers and women's perspectives [42] whilst one South Sudanese study included the perspectives of stakeholders from the local government sector, Faith-Based Organisations (FBOs), non-governmental organisations (NGOs), and community religious leaders in addition to healthcare providers [43].…”

“…Facilities had to call for an ambulance from another facility with sometimes delays [35]. In the absence of ambulances, donkey-driven carts, tractors, pick-up trucks, public transport (taxis and lorries), motorised tricycles and motorbikes were used for referral [40,29,33,36,37,42]. [42].…”

“…268 of 350 (76.6%) women who had been referred to a higher level facility in Ghana reported that healthcare providers were competent enough to solve their problems, however, details about providers' competencies were not explained [40]. In Kwara State in Nigeria, 128 (79.0%)…”