Abstract
ObjectivesMaternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services.MethodsThis was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach.ResultsThe availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support.ConclusionsPost-conflict health systems face different challenges in the delivery of EmONC services and as such require context-specific interventions to improve the delivery of these services.
Highlights
Improving maternal and neonatal health is challenging in conflict, post-conflict and other crisis settings [1,2,3,4,5,6]
Post-conflict health systems face different challenges in the delivery of emergency obstetric and neonatal care (EmONC) services and as such require context-specific interventions to improve the delivery of these services
This is partly associated with the delivery of disrupted and fragmented health services as health systems in such settings are characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of poorly organised non-governmental organisations [7]
Summary
Improving maternal and neonatal health is challenging in conflict, post-conflict and other crisis settings [1,2,3,4,5,6]. This is partly associated with the delivery of disrupted and fragmented health services as health systems in such settings are characterised by damaged infrastructure, limited human resources, weak stewardship and a proliferation of poorly organised non-governmental organisations [7]. Minor improvements have been observed since the global outlook of maternal and newborn health in conflict-affected settings remains gloomy. A recent study [5] found that countries that have recently experienced an armed conflict tend to have higher rates of maternal mortality compared to those that have not experienced such conflicts
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