Decentralized Public Delivery, Accessibility And Utilization of Maternal Health Services In Gida Ayana Woreda, Western Ethiopia
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Date
2020-06
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Addis Ababa University
Abstract
Objective: The specific objectives of this study were to explore the extent of implementation of
decentralized public health reform delivery and its effects on local service performance, to examine
behavioral factors influencing participants’ visits to decentralized healthcare facilities (DHFs) for
ANC visits as recommended, to identify delay factors for women’s choice of DHFs for child delivery,
to identify risk factors for non-utilization of DHFs for PNC and to model the spatial accessibility of
DHFs to target households in Gida Ayana Woreda, western Ethiopia.
Methods: Qualitative data were collected through IDI (from 29 randomly selected informants) and
FGD (with 8 groups from purposively selected community users). Quantitative data on utilization of
DHFs were collected from randomly selected 459 eligible women. A total of 459 random households
and 7 DHFs were geo-referenced. Software such as Epidata version 3.1, SPSS version 24.0, GIS
version 10.3, QGIS version 3.6, etc. were used. Qualitative data were analyzed for themes with the aid
of a decentralization framework and OpenCode 4.02.
Results: The qualitative data showed mixed results regarding decentralizations. The reform brought
some achievements such as improved autonomy over several areas of personnel management,
utilization of health care revenue, local resource mobilization, health service board and so forth. On
the other hand, decentralization was not able to ensure local community’s needs in service
programming. Inadequate capacity and capability in planning activities and implementing of facility
performance monitoring tools were also some other barriers. Chi-square and multinomial logistic
regression analyses were employed to examine the association between a set of behavioral factors and
visits to DHFs for ANC as recommended. Visit to DHFs for ANC was influenced by complex sets of
predisposing, enabling, perceived pregnancy needs and external environmental factors. Having fewer
than 2 children, home visits by HEWS, administrative decentralization unit and high fever were most
often explaining visits to DHFs for ANC. Phase I and Phase II delay factors driving women’s choices
of DHFs for child delivery were studied in a multivariable logistic regression model. Accordingly, most
women preferred DHFs to home for child delivery. Their choices were Phase I and Phase II delays
factors specific. Phase I delays were socio-cultural factors like literate women and support from local
traditional practice. Perceived needs were primarily planning to delivery at health facility, knowledge
of complications and home visit by HEWs. Physical accessibility (Phase II delays) included availability
of transportation and ‘health center’ type of DHFs. Regression model indicated that women who lived
in outer rural kebeles and 35 years or older were most significantly exposed to risks for non-utilization
PNC. Households’ SA to the closest DHFs in the form of shortest path walkways, traveling time and
Euclidian distance were analyzed by ArcGIS and QGIS. SA modeling has been skewed ‘because the
mean walking time of rural sample households to closest DHFs (in Tobler’s hiking time) was 62.4 min.
Conclusion: The study emphasized that, reducing woreda’s resource dependency, increasing local
decision power over recruitment of local staff, promoting bottom up service planning and monitoring,
etc should be given priority in order to enhance the effectiveness of the decentralisation of health
services. The study also emphasized that it is important to increase ANC and PNC service utilization
by improving on birth size and spacing; improving home visit by HEWs, increasing knowledge and
benefits of minimum maternal care visits. Local socio-economic development measures such as
targeting poor women/households; health education/promotion and reducing physical distance in rural
areas are critical for improving service utilization.
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Decentralized Public Delivery, Accessibility And Utilization of Maternal Health Services In Gida Ayana Woreda, Western Ethiopia