scholarly journals Supply-side barriers to maternal health care utilization at health sub-centers in India

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2675 ◽  
Author(s):  
Aditya Singh
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Utilization ◽  
Service Utilization ◽  
Maternal Health Care ◽  
Rural India ◽  
Care Utilization ◽  
Supply Side ◽  
Maternal Health Care Utilization ◽  
Care Services

IntroductionThere exist several barriers to maternal health service utilization in developingcountries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at health sub-centers (HSCs) in India, despite the fact that these institutions, which are the geographically closest available public health care facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India.Data and MethodsThis study uses health facility data from the nationally representativeDistrict-Level Household Survey, which was administered in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal health care services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables and exhibit considerable variability, the data were analyzed using negative binomial regression instead of Poisson regression.ResultsThe results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scales, and blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of a labor/examination table and bed screen is associated with a reduction in the number of deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephones, toilets, and electricity, are available at the HSCs. Monitoring of ANM’s work by Village Health and Sanitation Committee (VHSC) and providing in-service training to ANM appear to have positive impacts on service utilization. The distance of ANM’s actual residence from the sub-center village where she works is negatively associated with the utilization of delivery and postnatal services. These findings are robust to the inclusion of several demand-side factors.ConclusionTo improve maternal health care utilization at HSCs, the government shouldensure the availability of basic infrastructure, drugs, and equipment at all locations. Monitoring of the ANMs’ work by VHSCs could play an important role in improving health care utilization at the HSCs; therefore, it is important to establish VHSCs in each sub-center village. The relatively low utilization of maternity services in those HSCs that are run solely by contractual ANMs requires further investigation.

scholarly journals Determinants of Maternal Health Care Utilization in the Era of Free Maternity Services in Busia County, Kenya

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
B. Wafula ◽  
J. Arudo ◽  
M. Kipmerewo
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Services ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services ◽  
Maternal Health Care Services

Purpose. The main objective was to establish determinants of maternal health care utilization and specifically to assess the trends of maternal health care utilization and determine the predictors of maternal health care service utilization in the era of free maternity policy in Busia County. Methodology. It was a cross-sectional study design. The study was conducted between February and April 2019. The research targeted mothers within childbearing age of 15-49 years and a sample size of 634 mothers was used. Quantitative data were analyzed using SPSS version 22.0. Descriptive statistics was used to describe results on socio-demographic characteristics while inferential statistics employed bivariate and multivariate logistic regressions to investigate determinants of maternal health care utilization. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.  Results. In 2010, FANC increased by 5.6% from 2010 (pre-free maternity period) to 2017 (post-free maternity era). There was also an increase of 2.2% cases of health facility deliveries during pre-free maternity period (2010) and post-free maternity period (2017). Eleven predictors of maternal health care utilization were identified. Among them were respondent being a farmer (OR = 2.6; 95% CI: 1.4-4.8; p = 0.002), the status of the infrastructure of the nearest health facility maternity being good (OR = 3.2; 95% CI: 1.1-9.6; p = 0.03), fare for the public vehicle being USD 0.2 (OR = 3.4; 95% CI: 1.6-7.1; p = 0.001), all maternal health services being available in the nearest health facility (OR = 3.1; 95% CI: 1.8-5.4; p<0.0001), difficulty to attend MCH services due to non-suitability of working days (OR = 2.7; 95% CI: 1.5-4.7; p=0.0008), there being some services that clients pay for (OR = 3.3; 95% CI: 1.5-7.4; p=0.004), services being provided by nurses (midwives) (OR = 2.3; 95% CI: 1.0-4.9; p=0.04) , baby checkup being done within 24 hours by nurses (OR = 18.8; 95% CI: 8.0-44.0; p<0.0001. In conclusion, free maternity care program has led to increased utilization of facility ANC visits and deliveries in the study area. Barriers related to utilization of maternal health care services included unreliable transport especially at night, limited infrastructure and low socio-economic status of the women in the study area. National and county governments need to put in place strategies which will help them to jointly assess, map and plan investments to improve utilization of maternal health care services through prioritizing investments in human resource, infrastructure and commodities based on the anticipated demand for such services. A unique contribution to theory, practice, and policy: The study findings identified key factors that are unique to the mothers in Busia County on predisposing factors, enabling factors and the need characteristics that determine utilization of maternal health care in the era of Free Maternity services in the study area. These results contribute to both maternal health care utilization and policy change that could directly meet the social setting, geographical location and cultural needs of the people of Busia County.

scholarly journals Supply-side barriers to maternal health care utilization at health sub-centres in India

2016 ◽  
Author(s):  
Aditya Singh
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Health Care ◽  
Rural India ◽  
Care Utilization ◽  
Supply Side ◽  
Demand Side ◽  
Maternal Healthcare ◽  
Utilization Of Services ◽  
Maternal Health Care Utilization

Introduction: There exist several barriers to maternal health service utilization in developing countries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at Health Sub-Centers (HSC) in India, despite the fact that these institutions, as the nearest available public healthcare facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India. Data and Methods: This study uses health facility data from the nationally representative District-Level Household Survey, which was collected in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal healthcare services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables with considerable dispersion, the data has been analyzed using negative binomial regression instead of Poisson regression. Results: The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scale, blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of labor/examination table and bed screen is associated with a reduction in the number of safe deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephone, toilet, and electricity, are available at HSCs. Monitoring of an ANM’s work by the Village Health and Sanitation Committee (VHSC) and the in-service training of ANMs appear to have a positive impact on the utilization of services. The distance of an ANM’s actual residence from the sub-center village where she works is negatively associated with the utilization of delivery and postnatal services. These findings are robust to the inclusion of several demand-side factors. Conclusion: To improve maternal healthcare utilization at sub-centers, the government should ensure the availability of basic infrastructure, drugs, and equipment at all sub-centers. Monitoring of ANMs’ work by VHSCs could play an important role in improving healthcare utilization at the HSCs; therefore, it is important to establish VHSCs in each sub-center village. The issue of the relatively low utilization of maternity services in the HSCs that are run solely by contractual ANMs needs to be investigated further.

scholarly journals Supply-side barriers to maternal health care utilization at health sub-centres in India

2016 ◽  
Author(s):  
Aditya Singh
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Health Care ◽  
Rural India ◽  
Care Utilization ◽  
Supply Side ◽  
Demand Side ◽  
Maternal Healthcare ◽  
Utilization Of Services ◽  
Maternal Health Care Utilization

Introduction: There exist several barriers to maternal health service utilization in developing countries. Most of the previous studies conducted in India have focused on demand-side barriers, while only a few have touched upon supply-side barriers. None of the previous studies in India have investigated the factors that affect maternal health care utilization at Health Sub-Centers (HSC) in India, despite the fact that these institutions, as the nearest available public healthcare facilities in rural areas, play a significant role in providing affordable maternal health care. Therefore, this study aims to examine the supply-side determinants of maternal service utilization at HSCs in rural India. Data and Methods: This study uses health facility data from the nationally representative District-Level Household Survey, which was collected in 2007–2008 to examine the effect of supply-side variables on the utilization of maternal healthcare services across HSCs in rural India. Since the dependent variables (the number of antenatal registrations, in-facility deliveries, and postnatal care services) are count variables with considerable dispersion, the data has been analyzed using negative binomial regression instead of Poisson regression. Results: The results show that those HSCs run by a contractual auxiliary nurse midwife (ANM) are likely to offer a lower volume of services when compared to those run by a permanent ANM. The availability of obstetric drugs, weighing scale, blood pressure equipment is associated with the increased utilization of antenatal and postnatal services. The unavailability of labor/examination table and bed screen is associated with a reduction in the number of safe deliveries and postnatal services. The utilization of services is expected to increase if essential facilities, such as water, telephone, toilet, and electricity, are available at HSCs. Monitoring of an ANM’s work by the Village Health and Sanitation Committee (VHSC) and the in-service training of ANMs appear to have a positive impact on the utilization of services. The distance of an ANM’s actual residence from the sub-center village where she works is negatively associated with the utilization of delivery and postnatal services. These findings are robust to the inclusion of several demand-side factors. Conclusion: To improve maternal healthcare utilization at sub-centers, the government should ensure the availability of basic infrastructure, drugs, and equipment at all sub-centers. Monitoring of ANMs’ work by VHSCs could play an important role in improving healthcare utilization at the HSCs; therefore, it is important to establish VHSCs in each sub-center village. The issue of the relatively low utilization of maternity services in the HSCs that are run solely by contractual ANMs needs to be investigated further.

scholarly journals Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
N’doh Ashken Sanogo ◽  
Sanni Yaya
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Maternal Health ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Services Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

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