Menu
Menu
Menu
Menu
Introduction: In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. Methods: A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Results: Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. Conclusion: The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities.
Qualitative approach was considered most appropriate to answer the research questions on experiences and priority setting processes in EmOC service provision. To strengthen the credibility of the study findings, triangulation of data sources and methods was used. This included documentary reviews, in-depth interviews (IDIs) and focus group discussions (FGDs) to collect information. This study was conducted in Malindi district (now a sub-county of Kilifi County) in the coastal region of Kenya between November 2012 and April 2013. This was a follow up of an EU-funded five year intervention study “REsponse to ACcountable priority setting for Trust in health systems” (REACT). EmOC was one of the domains within the REACT project that was evaluated. During the time the study was conducted, the study site comprised of Malindi and Magarini, which have since been split into Malindi and Magarini Sub-counties. The area had 105 public and private health facilities [25]. There were three Comprehensive EmOC facilities, one public, and two private facilities, all located in Malindi town [12]. This study was conducted in six facilities from different sites, purposively selected with the assistance of the District Medical Officer of Health (DMOH). Among these, four were public health facilities; one, a health centre in level three and three dispensaries in level two. In addition, one faith based dispensary and two NGO run facilities were selected for the study. These facilities were selected due to the distance between them and the main referral facility in Malindi which pose a challenge in accessing maternal health services whenever there is a childbirth complication. The selected facilities are between 37km and 60km from the referral facility (12). The informants consisted of facility in-charges, reproductive health services heads, stakeholders and partners who provide and support maternal health services and health facility committee members who represent the community. At the community level, women, married men, traditional birth attendants (TBAs), opinion leaders and Community Health Workers (CHWs) were included in the study. Facility in-charges and heads of reproductive health services were included in the study by virtue of their positions at the facilities as planners and providers of maternal health services. Stakeholders, partners, faith based and non-governmental institutions were selected to share their views and experiences on maternal health issues with the community; and their support for priorities set for the public health system. Committee members were selected as community representatives. Women seeking health services were invited to give an interview and those who agreed were included in the study as end users; TBA group leaders and CHWs in the area were identified and included in the study to share their experiences with the community members. Opinion leaders were selected with the help of the facility in-charges to share their views on the topic. Male and female informants were recruited for FGDs with the help of opinion leaders in the areas. Men were included in the study as family decision makers. Approval to conduct this study was granted by the Ethical Review Committee of Kenya Medical Research Institute (Scientific Steering Committee No. 2288). Permission to conduct the study at the health facilities was granted by the then DMOH while written consent was given by the informants both at the facility and community levels. Permission to audio record the interviews was sought from each informant. A total of 22 IDIs and seven FGDs were conducted. IDIs were conducted with facility in-charges, reproductive health services heads, stakeholders and health facility committee members. Women seeking services at the facilities, TBAs, CHWs and opinion leaders were also interviewed. Three FGDs were conducted with male members as decision makers; three with women as the end users of delivery services and one with TBAs. Interview guides addressed the responsibilities of the interviewees, their understanding of priority setting, the process, maternal health issues in the district and their local settings, involvement of stakeholders, implementation of decisions in the AOPs, utilisation of the existing facilities, distribution of EmOC facilities and on what they do when they have women with delivery complications. The AFR conditions were factored in the guides. Specific questions regarding priorities in maternal health programs were directed to stakeholders and partners. These interviews included the kind of services offered and whether any special arrangements were in place with the existing public health system. Interviews with community members were on their experiences while seeking health services at the facilities, their role in priority setting and their perceptions towards priority setting for EmOC services. FGDs centered on challenges of access and utilisation of services by the service consumers; and decision making at the family level to seek EmOC services. The health personnel, stakeholders and partners were interviewed at their respective places of work. Committee members were interviewed at the health facilities where they are members while women were interviewed at the health facilities where they were seeking services. TBAs, CHWs, and opinion leaders were interviewed in their local health facility while FGDs were held at places that were convenient for the informants. Two health personnel and two committee members were not able to create time to participate; and two women declined because they did not have permission from their husbands to participate. Data collection was concluded when the target population had been covered. In total 15 documents were reviewed which included district health plans, national policy documents, guidelines and local publications. This review was carried out to facilitate further understanding of the priority setting process at the district. Data was analysed thematically. The process of identification of concepts was introduced as the data collection exercise continued. Guides were revised as new information was introduced in the study. Once all the data collection was finalized, it was transcribed verbatim. Interviews conducted in Kiswahili were translated into English. Transcribed data was given code numbers for anonymity. Data was explored to identify important and relevant themes of the study. These were subsequently labeled according to their relevance and a series of categories built up to explain the events that were emerging from the study. Emerging categories were merged to form core categories which are discussed in this paper. Categorization was done manually.
N/A
