“If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility”—A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services in Northern Ethiopia

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Study Justification:
– The study aimed to explore the perceptions of mothers and primary healthcare workers regarding inequities in maternal, newborn, and child health services in rural Ethiopia.
– Previous studies have shown that maternal health services in rural Ethiopia were distributed in a pro-rich manner, while child immunization coverage was more equitable.
– Understanding the factors influencing these differentials can help identify areas for improvement and inform efforts to provide universal health coverage for mothers, newborns, and children.
Highlights:
– The study conducted in-depth interviews and focus group discussions with mothers, women’s development group leaders, health extension workers, and health workers.
– Two major themes emerged: perceptions of inequity in the use of maternal and child health services, and perceived causes of inequity in service utilization.
– Mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service.
– Inequities were linked to poverty, lack of education, lack of access, and poor-quality services.
– Weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to contribute to health inequities.
– Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services.
Recommendations:
– Improve access to maternal, newborn, and child health services by addressing barriers related to poverty, education, and distance from health facilities.
– Enhance the quality of services to ensure equitable distribution.
– Strengthen the implementation of community-based equity-oriented policies, such as community-based health insurance.
– Empower women through poverty alleviation and education to increase their utilization of health services.
Key Role Players:
– Ministry of Health: Responsible for policy development and implementation.
– Local Government Authorities: Involved in resource allocation and coordination.
– Health Extension Workers: Provide primary healthcare services at the community level.
– Women’s Development Group Leaders: Play a role in community mobilization and awareness.
– Health Workers: Deliver healthcare services at health facilities.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers.
– Infrastructure development to improve access to health facilities.
– Outreach programs to reach remote areas.
– Awareness campaigns to promote health services.
– Monitoring and evaluation systems to track progress and identify gaps.

In earlier studies, we have shown that the utilization of maternal health services in rural Ethiopia was distributed in a pro-rich fashion, while the coverage of child immunization was equitably distributed. Hence, this study aimed to explore mothers’ and primary healthcare workers’ perceptions of inequities in maternal, newborn, and child health services in rural Ethiopia, along with the factors that could influence such differentials. A qualitative study was conducted from November to December 2019 in two rural districts in Tigray, Ethiopia. Twenty-two in-depth interviews and three focus group discussions were carried out with mothers who had given birth during the last year before the survey. We also interviewed women’s development group leaders, health extension workers, and health workers. The final sample was determined based on the principle of saturation. The interviews and focus group discussions were audiotaped, transcribed, translated, coded, and analyzed using thematic analysis. Two major themes emerged during the analysis that characterized the distribution of the service utilization and perceived causes of inequity. These were: (1) perceptions of the inequity in the use of maternal and child health services, and (2) perceived causes of inequity in maternal and child health service utilization. The mothers perceived antenatal care, facility-based delivery, and care-seeking for sick children to be inequitably distributed, while immunization was recognized as an equitable service. The inequity in the maternal and child health services was linked to poverty, lack of education, lack of access, and poor-quality services. The poor, the uneducated, and women who were distant from health facilities had a low utilization rate of services. The weak implementation of community-based equity-oriented policies, such as community-based health insurance, was perceived to result in health inequities. Mothers and primary healthcare providers in rural Ethiopia experienced weaknesses in delivering equitable services. The narratives could inform efforts to provide universal health coverage for mothers, newborns, and children by improving access and empowering women through poverty alleviation and education.

Based on the findings of the study titled “If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility,” the following recommendations can be developed into innovations to improve access to maternal health in rural Ethiopia:

1. Enhance education and awareness: Develop innovative educational programs specifically designed for women in rural areas to increase their knowledge about the importance of maternal health services. This can be done through the use of mobile health applications, interactive audio-visual materials, and community health workers who provide personalized education and counseling.

2. Improve infrastructure and transportation: Implement innovative solutions to address the lack of access to health facilities in rural areas. This can include the use of telemedicine and mobile clinics to provide remote consultations and services, the establishment of community birthing centers equipped with essential equipment, and the utilization of drones for emergency medical supply delivery.

3. Strengthen community-based health insurance: Innovate community-based health insurance schemes to ensure that financial barriers do not prevent women from accessing maternal health services. This can involve the use of mobile payment systems for premium collection and reimbursement, the integration of health insurance with existing social protection programs, and the establishment of community health financing mechanisms.

4. Empower women through poverty alleviation: Implement innovative poverty alleviation programs that empower women in rural areas. This can include the provision of entrepreneurship training and support for women to start their own income-generating activities, the establishment of women-led cooperatives for collective economic empowerment, and the integration of maternal health services with existing social welfare programs.

5. Improve quality of services: Utilize innovative approaches to enhance the quality of maternal health services in rural areas. This can involve the use of telemedicine and e-learning platforms for continuous professional development of healthcare providers, the implementation of quality improvement initiatives such as clinical audits and peer reviews, and the establishment of feedback mechanisms to gather patient perspectives on service quality.

By implementing these innovative recommendations, it is possible to improve access to maternal health services in rural Ethiopia and reduce inequities in utilization.
AI Innovations Description
The study titled “If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility” explores the inequities in the utilization of maternal, newborn, and child health services in rural Ethiopia. The study aims to identify factors that contribute to these inequities and provide recommendations for improving access to maternal health.

Based on the findings of the study, the following recommendations can be developed into innovations to improve access to maternal health:

1. Enhance education and awareness: Implement educational programs targeting women in rural areas to increase their knowledge about the importance of maternal health services. This can be done through community-based health education campaigns, workshops, and awareness-raising activities.

2. Improve infrastructure and transportation: Address the lack of access to health facilities by improving infrastructure and transportation systems in rural areas. This can include building or upgrading health facilities, providing ambulances or transportation services, and ensuring the availability of emergency obstetric care.

3. Strengthen community-based health insurance: Enhance the implementation of community-based health insurance schemes to ensure that financial barriers do not prevent women from accessing maternal health services. This can involve expanding coverage, reducing premiums, and increasing community participation in the management of health insurance programs.

4. Empower women through poverty alleviation: Address the underlying socio-economic factors that contribute to inequities in maternal health by implementing poverty alleviation programs. This can include providing income-generating opportunities, vocational training, and microfinance support to women in rural areas.

5. Improve quality of services: Enhance the quality of maternal health services in rural areas to increase utilization. This can be achieved through training and capacity building for healthcare providers, ensuring the availability of essential equipment and supplies, and implementing quality assurance mechanisms.

By implementing these recommendations, it is possible to improve access to maternal health services in rural Ethiopia and reduce inequities in utilization.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach can be used. Here is a brief description of the methodology:

1. Quantitative data collection: Conduct a survey to collect quantitative data on the utilization of maternal health services in rural Ethiopia. The survey should include questions related to women’s knowledge about maternal health, access to health facilities, utilization of services, and financial barriers. The survey can be administered to a representative sample of women in rural areas.

2. Qualitative data collection: Conduct in-depth interviews and focus group discussions with women who have given birth in the past year, women’s development group leaders, health extension workers, and health workers. The interviews and discussions should explore their perceptions of the barriers to accessing maternal health services and their views on the recommended interventions. The data collected should provide insights into the factors that contribute to inequities in service utilization and the potential impact of the recommendations.

3. Data analysis: Analyze the quantitative data using statistical methods to determine the current utilization rates of maternal health services and identify any disparities based on factors such as education, income, and distance to health facilities. Analyze the qualitative data using thematic analysis to identify common themes and patterns related to barriers and facilitators of access to maternal health services.

4. Simulation modeling: Develop a simulation model that incorporates the findings from the quantitative and qualitative data analysis. The model should simulate the impact of implementing the recommendations on improving access to maternal health services. This can be done by adjusting variables such as education levels, infrastructure improvements, availability of transportation, and the implementation of community-based health insurance. The model should estimate the potential changes in service utilization rates and identify any disparities that may still exist.

5. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model. This can involve varying the input parameters to test the model’s sensitivity to different scenarios and assumptions. Sensitivity analysis can help identify the key factors that have the most significant impact on improving access to maternal health services.

6. Policy recommendations: Based on the simulation results, develop policy recommendations for improving access to maternal health services in rural Ethiopia. These recommendations should be informed by the findings from the quantitative and qualitative data analysis, as well as the simulation model. The recommendations should address the identified barriers and inequities and provide actionable steps for policymakers and stakeholders.

By using this methodology, researchers can simulate the potential impact of the recommendations on improving access to maternal health services in rural Ethiopia and provide evidence-based policy recommendations for addressing the identified inequities.

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