The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study

Abstract

Background: Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply-and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products. Methods: To explore pregnant mothers' experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre-and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants' perceptions and experiences. Results: FGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education. Conclusions: Future interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.

Effective Coverage of Emergency Obstetric and Newborn Care Services in Africa: A Scoping Review

“…The Studies' Location and Types Most studies were from East and Western African countries (Figure 2). A variety of studies were included in the review, including 18 cross-sectional studies, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] seven qualitative studies, [40][41][42][43][44][45][46] one prospective before-after study, 47 one forthcoming chart review study, 48 two retrospective studies, 49,50 one mixed method study, 51 one interventional study, 52 and one observational study. 53 The Studies' Focus Most included studies targeted health facilities and a combination of at least two target populations (representing a combination of health facilities, women, care providers, stakeholders, and others).…”

“…The need for more efficiency in resource allocation, particularly scarcity of beds, rooms, supplies, and ambulances, challenged the provision of quality obstetric services in Burundi and Uganda, 45 Ethiopia, 41 Kenya, 40 and Nigeria. 47 This was further explained by a study from Ethiopia, where a unit decrease in satisfaction with the availability of medical supplies decreased the overall clients' satisfaction by 0.23 units.…”

“…34 The shortage of qualified staff and the increased workload were also reported as barriers to quality EmONC service provision. 40,42,[45][46][47] Effective communication was reported as one of the determining factors for delivering quality EmONC services. A study from Ghana reported that a lack of communication hampered pre-referral communication between facilities.…”

The Relationship between Age, Parity, Early Detection, K1-K4 Visits, Integrated ANC, Three Times Obgyn’s Ultrasound Examination, and Maternal Mortality

“…An effective strategy to reduce the risk of maternal and neonatal mortality is the integration of ANC (Hirai et al, 2020;Palmer et al, 2021). The results of hypothesis testing indicate that the integrated ANC has a significant influence on the maternal mortality.…”

Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya

“…Several interventions have been proposed to address both demand and supply-side barriers that lead to low levels of health service utilisation in low-and middle-income countries (LMICs). Supply-side interventions aim to improve the quality of healthcare offered, and include staff training, provision of supplies and results-based financing [10][11][12]. From 2016 in Kenya a supply-side intervention in the form of a results-based financing mechanism was scaled up nationally for selected maternal and child services [13].…”