Maternal health after Ebola: Unmet needs and barriers to healthcare in rural Sierra Leone

Health Policy and Planning, Volume 35, No. 1, Year 2020

Interpretation

Sierra Leone has the world’s highest estimated maternal mortality. Following the 2014-16 Ebola outbreak, we described health outcomes and health-seeking behaviour amongst pregnant women to inform health policy. In October 2016-January 2017, we conducted a sequential mixed-methods study in urban and rural areas of Tonkolili District comprising: household survey targeting women who had given birth since onset of the Ebola outbreak; structured interviews at rural sites investigating maternal deaths and reporting; and in-depth interviews (IDIs) targeting mothers, community leaders and health workers. We selected 30 clusters in each area: by random GPS points (urban) and by random village selection stratified by population size (rural). We collected data on health-seeking behaviours, barriers to healthcare, childbirth and outcomes using structured questionnaires. IDIs exploring topics identified through the survey were conducted with a purposive sample and analysed thematically. We surveyed 608 women and conducted 29 structured and 72 IDIs. Barriers, including costs of healthcare and physical inaccessibility of healthcare facilities, delayed or prevented 90% [95% confidence interval (CI): 80-95] (rural) vs 59% (95% CI: 48-68) (urban) pregnant women from receiving healthcare. Despite a general preference for biomedical care, 48% of rural and 31% of urban women gave birth outside of a health facility; of those, just 4% and 34%, respectively received skilled assistance. Women expressed mistrust of healthcare workers (HCWs) primarily due to payment demanded for ‘free’ healthcare. HCWs described lack of pay and poor conditions precluding provision of quality care. Twenty percent of women reported labour complications. Twenty-eight percent of villages had materials to record maternal deaths. Pregnant women faced important barriers to care, particularly in rural areas, leading to high preventable mortality and morbidity. Women wanted to access healthcare, but services available were often costly, unreachable and poor quality. We recommend urgent interventions, including health promotion, free healthcare access and strengthening rural services to address barriers to maternal healthcare.

AI Digest

Study Justification:

– Sierra Leone has the highest estimated maternal mortality rate in the world.
– The study aims to understand the health outcomes and health-seeking behavior of pregnant women in Sierra Leone after the Ebola outbreak.
– The findings will inform health policy and help address the unmet needs and barriers to healthcare in rural areas.

Study Highlights:

– Conducted a mixed-methods study in urban and rural areas of Tonkolili District.
– Surveyed 608 women and conducted structured interviews and in-depth interviews.
– Identified barriers to healthcare, including costs and physical inaccessibility.
– Found that 90% of rural pregnant women and 59% of urban pregnant women were delayed or prevented from receiving healthcare.
– Discovered that 48% of rural women and 31% of urban women gave birth outside of a health facility, with low rates of skilled assistance.
– Uncovered mistrust of healthcare workers due to payment demands for ‘free’ healthcare.
– Highlighted the lack of pay and poor conditions for healthcare workers, affecting the quality of care.
– Reported that 20% of women experienced labor complications.
– Revealed that only 28% of villages had materials to record maternal deaths.

Recommendations:

– Implement urgent interventions to address barriers to maternal healthcare.
– Conduct health promotion activities to raise awareness and educate women about the importance of seeking healthcare.
– Provide free healthcare access to pregnant women.
– Strengthen rural healthcare services to improve accessibility and quality of care.

Key Role Players:

– Ministry of Health: Responsible for implementing policy changes and allocating resources.
– Healthcare Workers: Need to be trained and supported to provide quality care.
– Community Leaders: Can play a role in promoting healthcare and addressing community-specific barriers.
– Non-Governmental Organizations (NGOs): Can provide support and resources to improve maternal healthcare.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare workers.
– Infrastructure development to improve healthcare facilities in rural areas.
– Health promotion campaigns and educational materials.
– Provision of free healthcare services for pregnant women.
– Monitoring and evaluation of interventions.
– Support from NGOs and donor funding.

Strength of Evidence

N/A

Abstract

Materials

N/A

Innovations

The study mentioned in the publication “Maternal health after Ebola: Unmet needs and barriers to healthcare in rural Sierra Leone” recommends the following strategies to improve access to maternal health in rural Sierra Leone:

1. Health Promotion: Implement health promotion campaigns to raise awareness about the importance of maternal healthcare and the available services. This can include educating women and communities about the benefits of seeking skilled assistance during childbirth and the potential risks of giving birth outside of a health facility.

2. Free Healthcare Access: Establish policies and programs that provide free or subsidized maternal healthcare services to reduce financial barriers. This can help ensure that cost is not a deterrent for pregnant women seeking healthcare.

3. Strengthen Rural Services: Invest in improving the quality and accessibility of healthcare facilities in rural areas. This can involve increasing the number of healthcare workers, providing training and resources to enhance their skills, and addressing issues related to payment demands and poor working conditions that contribute to mistrust.

By implementing these recommendations, it is hoped that barriers to maternal healthcare in rural Sierra Leone can be addressed, leading to improved access, reduced maternal mortality, and better health outcomes for pregnant women and their babies.

AI Innovations Description

The recommendation to improve access to maternal health in rural Sierra Leone, based on the study mentioned, includes the following:

1. Health Promotion: Implement health promotion campaigns to raise awareness about the importance of maternal healthcare and the available services. This can include educating women and communities about the benefits of seeking skilled assistance during childbirth and the potential risks of giving birth outside of a health facility.

2. Free Healthcare Access: Establish policies and programs that provide free or subsidized maternal healthcare services to reduce financial barriers. This can help ensure that cost is not a deterrent for pregnant women seeking healthcare.

3. Strengthen Rural Services: Invest in improving the quality and accessibility of healthcare facilities in rural areas. This can involve increasing the number of healthcare workers, providing training and resources to enhance their skills, and addressing issues related to payment demands and poor working conditions that contribute to mistrust.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health in rural Sierra Leone, the following methodology can be used:

1. Baseline Data Collection: Collect baseline data on the current state of maternal health in rural Sierra Leone. This can include information on maternal mortality rates, healthcare utilization, barriers to access, and health-seeking behaviors. This data will serve as a reference point for comparison after implementing the recommendations.

2. Intervention Implementation: Implement the three main recommendations mentioned in the abstract: health promotion campaigns, free healthcare access, and strengthening rural services. This can involve designing and executing targeted health promotion campaigns, establishing policies and programs for free or subsidized maternal healthcare services, and investing in improving healthcare facilities in rural areas.

3. Data Collection Post-Intervention: After implementing the recommendations, collect data on the impact of the interventions. This can include measuring changes in maternal mortality rates, healthcare utilization rates, and health-seeking behaviors. Data can be collected through surveys, interviews, and other relevant methods.

4. Data Analysis: Analyze the collected data to assess the impact of the interventions. Compare the post-intervention data with the baseline data to determine if there have been improvements in access to maternal health in rural Sierra Leone. This analysis can involve statistical methods to quantify the changes observed.

5. Evaluation and Recommendations: Evaluate the results of the analysis and draw conclusions about the effectiveness of the interventions. Based on the findings, provide recommendations for further improvements or adjustments to the interventions if necessary.

6. Dissemination of Findings: Share the findings of the simulation study with relevant stakeholders, including policymakers, healthcare providers, and community members. This can be done through reports, presentations, or other communication channels to ensure that the information reaches those who can take action based on the results.

By following this methodology, researchers and policymakers can gain insights into the potential impact of implementing the recommended interventions on improving access to maternal health in rural Sierra Leone.

Author

Dima Health

Statistics:

Citations: 13

Identifiers:

DOI: 10.1093/heapol/czz102

ISSN: 02681080

Research Areas:

Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care

Study Countries:

Sierra Leone

Study Design:

Cross Sectional Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female