Why Are Women Dying When They Reach Hospital on Time? A Systematic Review of the ‘Third Delay’

Abstract

BackgroundThe ‘three delays model’ attempts to explain delays in women accessing emergency obstetric care as the result of: 1) decision-making, 2) accessing services and 3) receipt of appropriate care once a health facility is reached. The third delay, although under-researched, is likely to be a source of considerable inequity in access to emergency obstetric care in developing countries. The aim of this systematic review was to identify and categorise specific facility-level barriers to the provision of evidence-based maternal health care in developing countries.Methods and FindingsFive electronic databases were systematically searched using a 4-way strategy that combined search terms related to: 1) maternal health care; 2) maternity units; 3) barriers, and 4) developing countries. Forty-three original research articles were eligible to be included in the review. Thirty-two barriers to the receipt of timely and appropriate obstetric care at the facility level were identified and categorised into six emerging themes (Drugs and equipment; Policy and guidelines; Human resources; Facility infrastructure; Patient-related and Referral-related). Two investigators independently recorded the frequency with which barriers relating to the third delay were reported in the literature. The most commonly cited barriers were inadequate training/skills mix (86%); drug procurement/logistics problems (65%); staff shortages (60%); lack of equipment (51%) and low staff motivation (44%).ConclusionsThis review highlights how a focus on patient-side delays in the decision to seek care can conceal the fact that many health facilities in the developing world are still chronically under-resourced and unable to cope effectively with serious obstetric complications. We stress the importance of addressing supply-side barriers alongside demand-side factors if further reductions in maternal mortality are to be achieved.

Maternal Near Miss: A Valuable Contribution in Maternal Care

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Cancer Presentation in a Developing Nation: The 3:1 Ratio

“…Adams et al adapted the WHO definition, and defined human resources for health as "the stock of all individuals engaged in the promotion, protection, or improvement of the health of the population" [13]. These were further classified into non -health professionals and health professionals [14,15]. Seeking care, advice or therapy from a higher health authority or body is the patient's perception of "presentation".…”

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