Determinants of access to and use of maternal health care services in the Eastern Cape, South Africa: A quantitative and qualitative investigation

  • BMC Research Notes, Volume 7, No. 1, Year 2014

listen audio

Study Justification:
– The study aims to examine whether women in Mdantsane, South Africa, are accessing and using maternal health care services.
– Access to maternal health care facilities is crucial for saving lives through the provision and use of essential maternal services.
– Understanding the factors associated with access and use of maternal health care services can help improve the delivery of these services.
Highlights:
– The study used a mixed methods approach, combining quantitative data from a structured questionnaire and qualitative data from one-on-one interviews with health care professionals.
– Quantitative analysis found that women aged 35-39, unmarried, with secondary education, government employees, and living within 20 km of a hospital were more likely to access maternal health services.
– Qualitative analysis revealed themes such as staff shortages, financial problems, lack of knowledge about maternal health care services, and their importance as barriers to utilization.
Recommendations:
– Include the media in broadcasting information about maternal health services and their importance.
– Implement educational programs to enhance the literacy skills of women, especially in rural areas.
– Develop and implement better policies to improve the livelihoods of women.
– Improve the delivery of maternal health care services in rural settings.
Key Role Players:
– Health care professionals (nurses, doctors, maternal health specialists) for providing insights and expertise.
– Media organizations for broadcasting information about maternal health services.
– Educators and literacy programs for enhancing the literacy skills of women.
– Policy makers for developing and implementing better policies.
– Health care organizations and providers for improving the delivery of maternal health care services.
Cost Items:
– Media broadcasting costs for disseminating information.
– Costs for implementing educational programs and literacy initiatives.
– Costs associated with policy development and implementation.
– Costs for improving infrastructure and resources in rural health care settings.
– Costs for training and capacity building of health care professionals.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, data collection methods, and findings. However, it lacks specific details about the sample size, response rate, and statistical significance of the results. To improve the evidence, the abstract could include these missing details and also provide more context on the study population and the generalizability of the findings.

Background: The main aim of the study is to examine whether women in Mdantsane are accessing and using maternal health care services. Accessibility of maternal health care facilities is important in ensuring that lives are saved through the provision and use of essential maternal services. Therefore, access to these health care services directly translates to use – that is, if women cannot access life-saving maternal health care services, then use of such services will be limited. Findings: The study makes use of mixed methods to explore the main factors associated with access to and use of maternal health care services in Mdantsane. For the quantitative approach, we collected data using a structured questionnaire. A sample of 267 participants was selected from health facilities within the Mdantsane area. We analyzed this data using bivariate and multivariate models. For the qualitative approach, we collected data from health care professionals (including nurses, doctors, and maternal health specialists) using one-on-one interviews. The study found that women who were aged 35-39, were not married, had secondary education, were government employees, and who had to travel less than 20 km to get to hospital were more likely to access maternal health services. The qualitative analysis provided the insights of health care professionals regarding the determinants of maternal health care use. Staff shortages, financial problems, and lack of knowledge about maternal health care services as well as about the importance of these services were among the major themes of the qualitative analysis. Conclusion: A number of strategies could play a big role in campaigning for better access to and use of maternal health services, especially in rural areas. These strategies could include (a) the inclusion of the media in terms of broadcasting information relating to maternal health services and the importance of such services, (b) educational programs aimed at enhancing the literacy skills of women (especially in rural areas), (c) implementing better policies that are aimed at shaping the livelihoods of women, and (d) implementing better delivery of maternal health care services in rural settings.

The qualitative approach involved collecting data from health care professionals, using one-on-one interviews. A range of questions were asked to gain the health professionals’ views on certain maternal health care problems which they encounter while working at the health facilities, as well as some of the barriers that hinder women from utilizing such services. The qualitative analysis involved selecting main themes from the responses of the interviewees and exploring those. For the analysis and interpretation, responses from two health professionals (out of each of the different professions – i.e. two doctors, two nurses, and two maternal health care specialists) were selected. The quantitative approach involved analysing data using bivariate and multivariate models. The participants were asked a range of questions, in a structured questionnaire format, regarding their access to maternal health care services and utilization of these services. Below are the variables that we selected for the study. We selected variables that were aimed at exploring the determinants of access to and use of maternal health services in the study area. For that reason, all the variables that were selected for the bivariate analysis were also included in the regression model. These variables are thus listed below. The dependent variables included: (a) access to maternal health services, which had dichotomous categories (0 = no; 1 = yes), and (b) antenatal visits for pregnancy, which had dichotomous categories (0 = 1 to 4; 1 = 5+). The independent variables included were: age (grouped into six categories: 15-19; 20-24; 25-29; 30-34; 35-39; 40 and above); marital status (dichotomous categories: 1 = married; 2 = not married); maternal education (grouped into four categories: none; primary; secondary; tertiary); occupation (grouped into six categories: none; housewife; self-employed; government employee; private employee; living on social grants); residential area (dichotomous categories: 1 = within Mdantsane; 2 = outside Mdantsane); distance to hospital/health facility (dichotomous categories: 1 = more than 20 km; 2 = less than 20 km); financial difficulties (grouped into three categories: difficult; not difficult; did not try to find/get money); means of transport (grouped into three categories: walk; public transport; private transport); cultural factors (dichotomous categories: 1 = yes; 2 = no); did you find the health care information useful? (dichotomous categories: 1 = yes; 2 = no); knowledge of antenatal services offered (dichotomous categories: 1 = yes; 2 = no); and medical aid (dichotomous categories: 1 = yes; 2 = no).

N/A

Based on the findings of the study, here are some recommendations that can be developed into innovations to improve access to maternal health:

1. Media involvement: Use media platforms such as public service announcements, radio programs, and television campaigns to raise awareness and educate women about available maternal health services.

2. Educational programs: Implement workshops, community outreach programs, and mobile health clinics to provide information about maternal health care, pregnancy, and childbirth, especially in rural areas.

3. Policy improvements: Develop policies that provide financial support for maternal health services, improve access to transportation, and address staff shortages in health facilities.

4. Improved delivery of maternal health care services: Establish more health facilities in rural areas, train and deploy more health care professionals, and improve the availability of essential maternal health care services.

By implementing these recommendations, access to maternal health care services can be improved, leading to a reduction in maternal mortality rates.
AI Innovations Description
Based on the findings of the study, here are some recommendations that can be developed into innovations to improve access to maternal health:

1. Media involvement: Include the media in broadcasting information about maternal health services and the importance of such services. This can be done through public service announcements, radio programs, and television campaigns to raise awareness and educate women about available maternal health services.

2. Educational programs: Implement educational programs aimed at enhancing the literacy skills of women, especially in rural areas. This can include providing information about maternal health care, pregnancy, and childbirth through workshops, community outreach programs, and mobile health clinics.

3. Policy improvements: Implement better policies that are aimed at shaping the livelihoods of women. This can include policies that provide financial support for maternal health services, improve access to transportation, and address staff shortages in health facilities.

4. Improved delivery of maternal health care services: Implement better delivery of maternal health care services in rural settings. This can involve establishing more health facilities in rural areas, training and deploying more health care professionals, and improving the availability of essential maternal health care services.

By implementing these recommendations, it is possible to improve access to maternal health care services and ultimately reduce maternal mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific population that the recommendations aim to benefit, such as women in rural areas or a specific region like Mdantsane in South Africa.

2. Collect baseline data: Gather data on the current state of access to maternal health care services in the target population. This can include information on the number of health facilities, availability of health care professionals, distance to hospitals, and utilization rates of maternal health services.

3. Develop a simulation model: Create a simulation model that incorporates the main recommendations and their potential impact on improving access to maternal health care services. This model should consider factors such as media involvement, educational programs, policy improvements, and improved delivery of services.

4. Input data and parameters: Input the baseline data and parameters into the simulation model. This includes information on the current state of access to maternal health care services, as well as the expected impact of each recommendation.

5. Run simulations: Run multiple simulations using different scenarios to assess the potential impact of the recommendations on improving access to maternal health care services. This can involve varying parameters such as the level of media involvement, the scale of educational programs, or the extent of policy improvements.

6. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health care services. This can include assessing changes in utilization rates, reduction in travel distances, or improvements in the availability of essential services.

7. Validate findings: Validate the findings of the simulations by comparing them with real-world data and existing studies on the impact of similar interventions. This helps ensure the accuracy and reliability of the simulation results.

8. Refine recommendations: Based on the simulation findings, refine the recommendations to optimize their potential impact on improving access to maternal health care services. This can involve adjusting the scale or scope of the interventions, identifying additional strategies, or addressing any potential limitations or challenges identified during the simulation process.

By following this methodology, researchers and policymakers can gain insights into the potential impact of the recommendations on improving access to maternal health care services and make informed decisions on implementing these interventions.


Statistics:
Citations: 28
Identifiers:
DOI: 10.1186/1756-0500-7-723
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Workforce
Study Countries:
South Africa
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
Share this:
Facebook
Twitter
LinkedIn
WhatsApp
Email