Abstract
BackgroundThe efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas.MethodsThis study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities.ResultsThe study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations.ConclusionsThe findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.
Highlights
The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies
Maternal and newborn deaths remain unacceptably high, in sub-Saharan Africa where more than one-half (56 %) of all maternal deaths continue to occur [6] and more than 1,000 000 children die within the first month of birth [7] with rural communities bearing the highest burden [6, 7]
Countries with high maternal and newborn deaths need to invest in universal access to essential Emergency Obstetric and Newborn Care (EmONC) services. that can deliver lifesaving services and interventions facilities [12, 13, 14]
Summary
The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. Maternal and newborn deaths remain unacceptably high, in sub-Saharan Africa where more than one-half (56 %) of all maternal deaths continue to occur [6] and more than 1,000 000 children die within the first month of birth [7] with rural communities bearing the highest burden [6, 7]. In these communities, poor women are confronted with infrastructural challenges, impeding access to health care and compromising health outcomes [8,9,10,11]. Water, adequate health personnel and in general, rural areas have poor roads that act as barriers in the access and referrals for maternal and newborn care [6, 17,18,19,20]. (See Table 1 for the signal functions and their infrastructural requirements)
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