Decentralized Public Delivery Accessibility And Utilization Of Maternal Health Services In Gida Ayana Woreda Western Ethiopia

Objective: The specific objectives of this study were to explore the extent of implementation ofrndecentralized public health reform delivery and its effects on local service performance, to examinernbehavioral factors influencing participants’ visits to decentralized healthcare facilities (DHFs) forrnANC visits as recommended, to identify delay factors for women’s choice of DHFs for child delivery,rnto identify risk factors for non-utilization of DHFs for PNC and to model the spatial accessibility ofrnDHFs to target households in Gida Ayana Woreda, western Ethiopia.rnMethods: Qualitative data were collected through IDI (from 29 randomly selected informants) andrnFGD (with 8 groups from purposively selected community users). Quantitative data on utilization ofrnDHFs were collected from randomly selected 459 eligible women. A total of 459 random householdsrnand 7 DHFs were geo-referenced. Software such as Epidata version 3.1, SPSS version 24.0, GISrnversion 10.3, QGIS version 3.6, etc. were used. Qualitative data were analyzed for themes with the aidrnof a decentralization framework and OpenCode 4.02.rnResults: The qualitative data showed mixed results regarding decentralizations. The reform broughtrnsome achievements such as improved autonomy over several areas of personnel management,rnutilization of health care revenue, local resource mobilization, health service board and so forth. Onrnthe other hand, decentralization was not able to ensure local community’s needs in servicernprogramming. Inadequate capacity and capability in planning activities and implementing of facilityrnperformance monitoring tools were also some other barriers. Chi-square and multinomial logisticrnregression analyses were employed to examine the association between a set of behavioral factors andrnvisits to DHFs for ANC as recommended. Visit to DHFs for ANC was influenced by complex sets ofrnpredisposing, enabling, perceived pregnancy needs and external environmental factors. Having fewerrnthan 2 children, home visits by HEWS, administrative decentralization unit and high fever were mostrnoften explaining visits to DHFs for ANC. Phase I and Phase II delay factors driving women’s choicesrnof DHFs for child delivery were studied in a multivariable logistic regression model. Accordingly, mostrnwomen preferred DHFs to home for child delivery. Their choices were Phase I and Phase II delaysrnfactors specific. Phase I delays were socio-cultural factors like literate women and support from localrntraditional practice. Perceived needs were primarily planning to delivery at health facility, knowledgernof complications and home visit by HEWs. Physical accessibility (Phase II delays) included availabilityrnof transportation and ‘health center’ type of DHFs. Regression model indicated that women who livedrnin outer rural kebeles and 35 years or older were most significantly exposed to risks for non-utilizationrnPNC. Households’ SA to the closest DHFs in the form of shortest path walkways, traveling time andrnEuclidian distance were analyzed by ArcGIS and QGIS. SA modeling has been skewed ‘because thernmean walking time of rural sample households to closest DHFs (in Tobler’s hiking time) was 62.4 min.rnConclusion: The study emphasized that, reducing woreda’s resource dependency, increasing localrndecision power over recruitment of local staff, promoting bottom up service planning and monitoring,rnetc should be given priority in order to enhance the effectiveness of the decentralisation of healthrnservices. The study also emphasized that it is important to increase ANC and PNC service utilizationrnby improving on birth size and spacing; improving home visit by HEWs, increasing knowledge andrnbenefits of minimum maternal care visits. Local socio-economic development measures such asrntargeting poor women/households; health education/promotion and reducing physical distance in ruralrnareas are critical for improving service utilization.

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