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Perceived barriers to maternal and newborn health services delivery: a qualitative study of health workers and community members in low and middle-income settings
  1. Joshua Sumankuuro1,2,
  2. Judith Crockett1,
  3. Shaoyu Wang1
  1. 1 Youth Alive Ghana, Tamale, Ghana
  2. 2 School of Community Health,Faculty of Science, Charles SturtUniversity, Orange, New SouthWales, Australia
  1. Correspondence to Joshua Sumankuuro; ijoshua200{at}


Objectives In considering explanations for poor maternal and newborn health outcomes, many investigations have focused on the decision-making patterns and actions of expectant mothers and families, as opposed to exploring the ‘supply side’ (health service provider) barriers. Thus, we examined the health system factors impacting on access to and delivery of quality maternal and newborn healthcare in rural settings.

Design A semistructured qualitative study using face-to-face in-depth interviews with health professionals, and focus group sessions with community members, in eight project sites in two districts of Upper West Region, Ghana, was employed. Participants were purposively selected to generate relevant data to help address the study objective. The survey was guided by WHO standard procedures and Ghana Health Ministry’s operational work plan for maternal and newborn care.

Setting Nadowli–Kaleo and Daffiama–Bussie–Issa districts in Upper West Region, Ghana.

Participants Two hundred and fifty-three participants were engaged in the study through convenient and purposive sampling: healthcare professionals (pharmacist, medical doctor, two district directors of health services, midwives, community health and enrolled nurses) (n=13) and community members comprising opinion leaders, youth leaders and adult non-pregnant women (n=240 in 24 units of focus groups).

Results Results show significant barriers affecting the quality and appropriateness of maternal and neonatal health services in the rural communities and the Nadowli District Hospital. The obstacles were inadequate medical equipment and essential medicines, infrastructural challenges, shortage of skilled staff, high informal costs of essential medicines and general limited capacities to provide care.

Conclusion Implementation of the birth preparedness and complication readiness strategy is in its infancy at the health facility level in the study areas. Increasing the resources at the health provider level is essential to achieving international targets for maternal and neonatal health outcomes and for bridging inequities in access to essential maternal and newborn healthcare.

  • health facilities
  • birthing centres
  • maternal care patterns
  • newborn care
  • health attitude
  • ghana

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  • Contributors Conceived and designed: all authors. Participant recruitment: JS and JC. Data collection, analysis, interpretation and writing of the first draft of the manuscript: JS. Contribution to study interpretation and manuscript review: all authors. All authors contributed substantially to the writing of the manuscript, reviewed and approved the final write-up for submission.

  • Funding This research is funded by Ghana Education Trust Fund (GETFUND) Doctorate Studentship to JS.

  • Disclaimer GETFUND had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approvals from Charles Sturt Human Research Ethics Committee (protocol numbers: 2016/013 and H16178 and Regional Health Directorate of Upper West Region.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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