Abstract
BackgroundDelays in accessing skilled delivery services are a major contributor to high maternal mortality in resource-limited settings. In 2015, the government of The Gambia initiated a results-based financing intervention that sought to increase uptake of skilled delivery. We performed a midline evaluation to determine the impact of the intervention and explore causes of delays.MethodsA mixed methods design was used to measure changes in uptake of skilled delivery and explore underlying reasons, with communities randomly assigned to four arms: (1) community-based intervention, (2) facility-based intervention, (3) community- and facility-based intervention, and (4) control. We obtained quantitative data from household surveys conducted at baseline (n = 1423) and midline (n = 1573). Qualitative data came from semi-structured interviews (baseline n = 20; midline n = 20) and focus group discussions (baseline n = 27; midline n = 39) with a range of stakeholders. Multivariable linear regression models were estimated using pooled data from baseline and midline. Qualitative data were recorded, transcribed, translated and thematically analyzed.ResultsNo increase was found in uptake of skilled delivery services between baseline and midline. However, relative to the control group, significant increases in referral to health facilities for delivery were found in areas receiving the community-based intervention (beta = 0.078, p < 0.10) and areas receiving both the community-based and facility-based interventions (beta = 0.198, p < 0.05). There was also an increase in accompaniment to health facilities for delivery in areas receiving only community-based interventions (beta = 0.095, p < 0.05). Transportation to health facilities for delivery increased in areas with both interventions (beta = 0.102, p < 0.05). Qualitative data indicate that delays in the decision to seek institutional delivery usually occurred when women had limited knowledge of delivery indications. Delays in reaching a health facility typically occurred due to transportation-related challenges. Although health workers noted shortages in supplies and equipment, women reported being supported by staff and experiencing minimal delays in receiving skilled delivery care once at the facility.ConclusionsFocusing efforts on informing the decision to seek care and overcoming transportation barriers can reduce delays in care-seeking among pregnant women and facilitate efforts to increase uptake of skilled delivery services through results-based financing mechanisms.
Highlights
Delays in accessing skilled delivery services are a major contributor to high maternal mortality in resource-limited settings
Delays in the decision to seek care can occur when family members oppose facility delivery, women fear facility delivery, women feel embarrassed by physical examinations at the health facility, family members feel no perceived need for facility delivery, women lack knowledge about the importance of facility delivery, or families lack the resources to pay for a facility delivery [4, 11,12,13,14,15]
Delays in reaching an adequate health facility can occur when women try to access a health facility from remote areas, women lack access to all-weather roads, labor begins at night or during poor weather, women lack someone to accompany them to a health facility, or women lack transportation or the means to pay for it [11,12,13,14,15]
Summary
Delays in accessing skilled delivery services are a major contributor to high maternal mortality in resource-limited settings. In 2015, an estimated 303,000 women died globally during pregnancy, childbirth or within 42 days of delivery [1] Most of these deaths occurred in resource-limited settings and would have been preventable had appropriate services been accessed [2]. In recent years, several RBF programs have been shown to increase rates of institutional delivery in resource-limited settings [4,5,6,7,8,9] In most cases, this implies increases in rates of skilled delivery, as skilled delivery, as defined by the World Health Organisation, is not available outside health facilities [10]. Delays in receiving adequate care at the health facility can occur when health facilities lack the necessary resources and personnel for delivery or do not prepare for delivery in advance [11, 16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
