Mapping of Household Surveys to Measure Barriers to Access to Maternal and Child Health Services in India

Abstract

Objective: To map the range of access barrier indicators for which data can be derived from the three most common health related household surveys in India. Methods: A mapping review study was conducted to identify access dimensions and indicators of access barriers for maternal and child health (MCH) services included in three household surveys in India: National Family Health Survey (NFHS), District Level Household and Facility Survey (DLHS) and Annual Health Survey (AHS). Results: The Tanahashi framework for effective coverage of health services was used in this study, and 12 types of access barriers were identified, from which 23 indicators could be generated. These indicators measure self-reported access barriers for unmet healthcare needs through delayed care, as well as forgone care, and unsatisfactory experiences during health service provision. Multiple barriers could be identified, although there was marked heterogeneity in variables included and how barriers were measured. Conclusions: This study identified tracer indicators that could be used in India to monitor the population that experiences healthcare needs but fails to seek and obtain appropriate healthcare, and determine what the main barriers are. The surveys identified are well validated and allow the disaggregation of these indicators by equity stratifiers. Given the variability of the frequency and methodologies used in these surveys, comparability could be limited.

Barriers in utilization and provisioning of obstetric care services (OCS) in India: a mixed-methods systematic review

“…Long distance to health facilities [ 1 , 5 , 9 , 10 , 12 , 13 , 15 , 17 , 28 , 29 , 33 , 35 , 47 , 65 , 50 , 64 ] and lack of transportation facilities [ 11 , 14 , 16 , 26 , 28 , 32 , 33 , 47 , 48 , 50 , 58 , 63 ] were major logistical barriers to accessing OCS. Such barriers were frequently reported from rural and geographically-isolated regions of India [ 10 , 11 , 35 ] and were a significant contributor to the underutilization of OCS services in the remote locations of India [ 10 , 58 , 60 ].…”

“…Previous studies have documented that poor quality of treatment [ 4 , 17 , 25 , 28 , 33 – 35 , 47 , 50 , 54 , 64 , 65 , 68 ] and non-cooperative attitude of health professionals were responsible for hesitation in women and their families to seek OCS [ 14 , 20 , 25 , 50 , 54 , 69 ]. Previous studies also reveal that disrespectful behavior of health professionals towards pregnant women is another major barrier to institutional delivery [ 20 , 50 , 54 ].…”

Addressing barriers in utilization and provisioning of obstetric care services (OCS) in India: A mixed method systematic review

“…Previous studies documented that poor quality of treatment [4,17,25,26,28,33,34,35,40,41,44,49,53,59] and the non-cooperative attitude of health professionals were responsible for women and their families in hesitating to seek OCS [14,20,25,44,53,54]. Previous studies also reveal that disrespectful behaviors of health professionals toward pregnant women are major barriers to institutional deliveries [20,44,53].…”

“…Other studies also reported that the unavailability of labor rooms, long waiting time in the health facility, and lack of medical equipment and infrastructure are driving barriers to home delivery in India [12,15,26,36,41,49].…”

“…On the other hand, women are deterred from completing their ANC services due to health system-related barriers such as the unavailability of trained health personnel [10,36,41,49,52,53], long waiting time in hospitals [15,26,36,41,44,55], inadequate equipment and shortage of drugs [9,12,26,36,40,49,59], and poor health infrastructure [9,10,15,36,49,54]. In this context, a previous study explained that non-availability of adequate beds, labour/examination tables, and bed screens signi cantly reduced the volume of antenatal registrations and postnatal services [9,12].…”