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Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia

BACKGROUND: Evidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric care, are still contributing to maternal deaths in low-income countries. Ethiopia is a major contributor to the worldwide death toll of mothe...

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Autores principales: Gebrehiwot, Tesfay, San Sebastian, Miguel, Edin, Kerstin, Goicolea, Isabel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997189/
https://www.ncbi.nlm.nih.gov/pubmed/24716750
http://dx.doi.org/10.1186/1471-2393-14-137
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author Gebrehiwot, Tesfay
San Sebastian, Miguel
Edin, Kerstin
Goicolea, Isabel
author_facet Gebrehiwot, Tesfay
San Sebastian, Miguel
Edin, Kerstin
Goicolea, Isabel
author_sort Gebrehiwot, Tesfay
collection PubMed
description BACKGROUND: Evidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric care, are still contributing to maternal deaths in low-income countries. Ethiopia is a major contributor to the worldwide death toll of mothers with a maternal mortality ratio of 676 per 100,000 live births. The Ethiopian Ministry of Health launched a community-based health-care system in 2003, the Health Extension Programme (HEP), to tackle maternal mortality. Despite strong efforts, universal access to services remains limited, particularly skilled delivery attendance. With the help of ‘the three delays’ framework, this study explores health-service providers’ perceptions of facilitators and barriers to the utilization of institutional delivery in Tigray, a northern region of Ethiopia. METHODS: Twelve in-depth interviews were carried out with eight health extension workers (HEWs) and four midwives. Each interview lasted between 90 and 120 minutes. Data were analysed through a thematic analysis approach. RESULTS: Three themes emerged from the analysis: the struggle between tradition and newly acquired knowledge, community willingness to deal with geographical barriers, and striving to do a good job with insufficient resources. These themes represent the three steps in the path towards receiving adequate institutional delivery care at a health facility. Of the themes, ‘increased community awareness’, ‘organization of the community’ and ‘hospital with specialized staff’ were recognized as facilitators. On the other hand, ‘delivery as a natural event’, ‘cultural tradition and rituals’, ‘inaccessible transport’, ‘unmet community expectation’ and ‘shortage of skilled human resources’ were represented as barriers to institutional delivery. CONCLUSIONS: The participants in this study gave emphasis to the major barriers to institutional delivery that are closely connected with the three delays model. Despite the initiatives being implemented by the Tigray Regional Health Bureau, much is still needed to enhance the humanization approach of delivery care on a broader level of the region. A quick solution is needed to address the major issue of lack of transport accessibility. The poor capacity of the HEWs to provide delivery services, calls for reconsidering staffing patterns of remote health posts and readdressing the issue of downgraded health facilities would address unmet community needs.
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spelling pubmed-39971892014-04-24 Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia Gebrehiwot, Tesfay San Sebastian, Miguel Edin, Kerstin Goicolea, Isabel BMC Pregnancy Childbirth Research Article BACKGROUND: Evidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric care, are still contributing to maternal deaths in low-income countries. Ethiopia is a major contributor to the worldwide death toll of mothers with a maternal mortality ratio of 676 per 100,000 live births. The Ethiopian Ministry of Health launched a community-based health-care system in 2003, the Health Extension Programme (HEP), to tackle maternal mortality. Despite strong efforts, universal access to services remains limited, particularly skilled delivery attendance. With the help of ‘the three delays’ framework, this study explores health-service providers’ perceptions of facilitators and barriers to the utilization of institutional delivery in Tigray, a northern region of Ethiopia. METHODS: Twelve in-depth interviews were carried out with eight health extension workers (HEWs) and four midwives. Each interview lasted between 90 and 120 minutes. Data were analysed through a thematic analysis approach. RESULTS: Three themes emerged from the analysis: the struggle between tradition and newly acquired knowledge, community willingness to deal with geographical barriers, and striving to do a good job with insufficient resources. These themes represent the three steps in the path towards receiving adequate institutional delivery care at a health facility. Of the themes, ‘increased community awareness’, ‘organization of the community’ and ‘hospital with specialized staff’ were recognized as facilitators. On the other hand, ‘delivery as a natural event’, ‘cultural tradition and rituals’, ‘inaccessible transport’, ‘unmet community expectation’ and ‘shortage of skilled human resources’ were represented as barriers to institutional delivery. CONCLUSIONS: The participants in this study gave emphasis to the major barriers to institutional delivery that are closely connected with the three delays model. Despite the initiatives being implemented by the Tigray Regional Health Bureau, much is still needed to enhance the humanization approach of delivery care on a broader level of the region. A quick solution is needed to address the major issue of lack of transport accessibility. The poor capacity of the HEWs to provide delivery services, calls for reconsidering staffing patterns of remote health posts and readdressing the issue of downgraded health facilities would address unmet community needs. BioMed Central 2014-04-10 /pmc/articles/PMC3997189/ /pubmed/24716750 http://dx.doi.org/10.1186/1471-2393-14-137 Text en Copyright © 2014 Gebrehiwot et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research Article
Gebrehiwot, Tesfay
San Sebastian, Miguel
Edin, Kerstin
Goicolea, Isabel
Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title_full Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title_fullStr Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title_full_unstemmed Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title_short Health workers’ perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
title_sort health workers’ perceptions of facilitators of and barriers to institutional delivery in tigray, northern ethiopia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997189/
https://www.ncbi.nlm.nih.gov/pubmed/24716750
http://dx.doi.org/10.1186/1471-2393-14-137
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