Recherche en médecine familiale et en sciences médicales
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Perceptions of Mothers, Health Development Army and Health Extension Workers on Maternal and Newborn Health Care Services Utilization in 25 Districts of Four Ethiopian Regions: A Qualitative Study

Geremew Gonfa*, Erin M Carthy, Joanna Busza, Habtamu Teklie, Theodros Getachew, Girum Taye, Misrak Getinet, Tefera Tadele, Abebe Bekele, Atkure Defar

Background: Nearly half of all maternal deaths worldwide occur in Africa. In Ethiopia maternal mortality is still high. Maternal service utilization has great role in reducing maternal deaths. This study explored the perception that mothers, health development army members, and health extension workers have on maternal and newborn healthcare services in 25 selected districts of four Ethiopian regions.

Methods: A qualitative cross-sectional study was conducted in the 25 woredas selected from four Ethiopian regions; Amhara, South Nation Nationalities and People, Oromia and Tigray regions from July to August, 2013. We conducted 50 focus group discussions and 25 in-depth interviews. In each of the 25 districts (woredas) selected, each district consisted; 2 focus groups discussions (with mothers and local health development army) and an in-depth- interview with a health extension worker per district. The data transcribed in to the local languages and translated into English and narrated analyzed thematically

Results: Supply side constraints including lack of skills, training and supportive supervision were find to be barriers to the provision of high-quality care by health staff and constituted a source of frustration. At the community-level, these gaps are recognized, reinforcing the perception that health facilities are deficient and not worth the costs of seeking out health services. Perceptions of quality were tied to friendliness, proximity of the facility to home, short waiting times, and ability to access many services as possible during one appointment. Delivery in the home remains a common practice, however efforts to integrate clinical practice with traditional rituals improve uptake of services.

Conclusion: Despite the progress made to increase the availability of maternal healthcare, this study sheds light on inadequate levels of care that effect uptake. The absence of supplies, inadequate staffing, and difficulties in obtaining drugs were all mentioned as barriers to utilization of MNH services. In order to improve quality of care more effort is needed to address supply and demand side barriers affecting service utilization including sustained education and the development of culturally appropriate solutions that meet the needs of communities in Ethiopia.Despite the progress made to increase the availability of maternal healthcare, this study sheds light on inadequate levels of care that effect uptake. The absence of supplies, inadequate staffing, and difficulties in obtaining drugs were all mentioned as barriers to utilization of MNH services. In order to improve quality of care more effort is needed to address supply and demand side barriers affecting service utilization including sustained education and the development of culturally appropriate solutions that meet the needs of communities in Ethiopia.