Menu
Menu
Menu
Menu
Background: In fragile and war-affected setting such as South Sudan, a combination of physical environmental, socioeconomic factors and healthcare’s characteristic contributes to higher rates of home delivery attended by unskilled attendants. This study aims to understand the community members’ experience, perceptions and the barriers in relation to accessing and utilizing maternal healthcare services in South Sudan. Methods: We conducted in-depth one-on-one interview with 30 women and 15 men to investigate their perspectives on the barriers to access maternal and child health related services. We purposively selected women and their partners in this study. Results: Our study revealed that inadequate quality of antenatal care services such as lack of essential medicine, supplies and tools was linked to individual’s mothers dissatisfaction with the services they received. In addition, sudden onset of labor and lack of safety and security were important reasons for home delivery in this study. Furthermore, lack of transport as a result of a combination of long distance to a facility and associated costs either restricted or delayed women reaching the health facilities. Conclusions: Our study highlighted an urgent need for the government of South Sudan to implement security and safety measures in order to improved access to delivery service at night. Incorporating private transports to provide access to affordable and reliable transport services for pregnant and post-partum women is also important. Increasing the budget allocation for medicine and health supplies and improving management of medicine and supply chain logistics are essential.
This analysis was part of a wider study conducted in early December 2015 to end of January 2016 in Juba county central Equatoria State. We purposively selected health services located in Juba town, Kator, and Munuki for security and accessibility reasons. The wider study aimed to explore the perceived and experienced barriers faced by the community members to access healthcare services, as well as the barriers faced by the healthcare providers to deliver healthcare services to their client. The current paper reports the findings generated from the women and their husbands on perceived and experienced barriers to receiving maternal health services at the Juba Teaching Hospital, the Juba Military Hospital, and the Nykory Primary Health Care Center. Our study participants consisted of 30 mothers, 10 in each type of health care facility, with children aged less than 3 months, who had given birth either at home or in a health facility, and 15 husbands (5 in each health care facility). Prior to data collection we recruited and trained one research assistant in qualitative data collection methods. We conducted in-depth one-on-one interviews firstly with all mothers then secondly we cross check the information with their husbands to investigate each individual’s perspectives on the barriers to access to maternal and child health related services. Interviews with women were conducted in a confidential place mostly on the premises of the health facility at each of the selected health facility for their convenience and ease accessibility. Interviews with husbands were conducted at the Juba Staff Club. To recruit the husbands, firstly we purposively selected eligible women who were willing to participate in the study. The husbands who were accompanying their wife were invited to participate and the consented husbands were interviewed. If the woman was alone or accompanied by anyone other than her husband, we collected the husband’s contact details to make an attempt to contact him. Through this process we finally interviewed 15 husbands. All interviews were conducted in local South Sudan Arabic. We developed and used separate guidelines to administer the in-depth interviews with each type of respondent. All the interviews were audio recorded. We followed multiple steps to analyze the data. First, the lead researcher (NSM) transcribed verbatim each audio-recorded interview conducted in the local language and then translated the interview into English and saved it as Microsoft Word document. Second, a team of two researchers crosschecked the translation against the audio recording and the transcription. Third, NSM prepared a draft code list by carefully reading two transcripts, which were independently checked by another researcher (AA). Subsequently NSM and AA discussed the draft code list and developed a code list. NSM then manually coded all transcripts. As the study was explorative and descriptive in nature, we applied an inductive coding procedure where themes were derived from the data that were related to our research questions [23]. Fourth, the data were organized and compiled into separate files based on each thematic code. Fifth, involved the development of themes, which were classified according to the objective of the study. We applied an inductive thematic approach for data analysis [24]. The analysis team discussed the text pertaining to each thematic code. After several discussions these were consolidated and summarised in a document for each theme with relevant quotes and text tables. At the end we performed a triangulation of data to compare different responses from mothers and their spouses [25]. We modified and used the framework developed by Peter at el [26] as a guide to examine and group the key challenges and barriers facing women to access health care services in South Sudan. Figure 3 presents the main challenges identified in this study. According to the framework the distal factors such as policy and or macro-environment have direct effects on the household, community and health facility. In turn, the characteristics of the health facility and the household and community affect the individual mother’s use or nonuse of the services. We classified the challenges into five main categories including: 1) geographical accessibility (the impact of distance and transport to maternal health care services); 2) availability (having access to appropriate types of care to the women who need them); 3) affordability (capacity and willingness to pay for the services); 4) acceptability (the response of health care providers to the social and cultural expectation of the community and the women attending their services); and 5) Security factors (the impact of safety and security instability on community access to healthcare services). Perceptions of community members on the challenges faced by woman to access and utilize health service. This framework was developed from Peter at el framework
N/A
