Strategies to promote optimal utilisation of maternal healthcare services at primary healthcare centres in Pemba Island, Zanzibar

Abstract

Maternal healthcare is healthcare services provided to women during pregnancy, childbirth, and postnatal period. Underutilisation of maternal healthcare services, specifically during delivery and postnatal period, is a deterrent to the efforts to reduce maternal mortality and morbidity globally. In middle and low-income countries, Tanzania among them, many women attend at least one antenatal care, but only a few make the recommended eight contacts due to health policy and population-related reasons. Additionally, some women do not deliver at health facilities and do not continue with postnatal services as they do not see the need. This study aimed to explore community perceptions of utilising facility-based maternal healthcare services in Wete Pemba Island and develop strategies to promote optimal utilisation. A qualitative explorative descriptive design was used to obtain data through individual interviews with women (n=16) and men (n=15), as well as four focus group discussions with nurse-midwives (NMs) (n=19). Data collection was done using a semi-structured interview guide and analysed thematically using MAXQDA2020. The emergent themes are categorised into perceived promoters and impeders of optimum utilisation of facility-based maternal healthcare services, and the third theme was the participants’ suggestions for enhancing facility-based maternal health service utilisation. The promoters include good maternal healthcare services, family and spouse support, comprehensive services under one roof, and good education, counselling, and advice. The impeders are cultural practices, family power relations and decision-making, religious beliefs, distance to health facilities, trust in traditional birth attendants (TBAs), fear of testing for HIV, health professionals’ attitudes, shortage of staff, unconducive physical infrastructure, inadequate medical equipment, and supplies, including medicines. The suggestions from the findings were: ensure the availability of medical supplies, medical equipment, and ambulance; staffing issues – shortage and attitude toward patients (Pts);emphasise health education/information to the community; and upgrade physical infrastructure. The study results were evaluated using the SWOT analysis to develop strategies for promoting optimal utilisation of facility-based maternal healthcare services. In conclusion, the findings indicate that the utilisation of facility-based maternal healthcare services within the community is generally appreciated. However, there is a need to reinforce the identified promoters and address impeders to achieve optimal utilisation. Hence, the proposed strategies will be presented later in the study.

Moedergesondheidsorg behels gesondheidsorgdienste wat verleen word aan vroue tydens swangerskap, bevalling en die nageboortetydperk. Onderbenutting van moedergesondheidsorgdienste, spesifiek tydens bevalling en die nageboortetydperk, werk pogings teë om moedersterftes en -morbiditeit wêreldwyd te verminder. In middel- en lae-inkomste lande, insluitend Tanzanië, woon baie vroue ten minste een voorgeboortesorgsessie by, maar vir gesondheidsbeleid- en bevolkingsverwante redes woon slegs ’n paar die aanbevole agt kontaktsessies by. Verder skenk sommige vroue nie by gesondheidsfasiliteite geboorte nie en gaan nie voort met nageboortedienste nie, aangesien hulle nie die behoefte sien om dit te doen nie. Die studie is uitgevoer om gemeenskappersepsies van die gebruik van fasiliteit-gebaseerde moedergesondheidsorgdienste in Wete Pemba-eiland te ondersoek en strategieë te ontwikkel om optimale benutting te bevorder. ’n Kwalitatiewe eksploratiewe beskrywende ontwerp is gebruik om data te bekom deur individuele onderhoude met vroue (n = 16) en mans (n = 15), asook deur vier fokusgroepbesprekings met verpleegster-vroedvroue (n = 19). Data-insameling is gedoen met behulp van ’n semi-gestruktureerde onderhoudsgids en data is tematies ontleed deur gebruik te maak van MAXQDA2020. Drie temas het na vore gekom, naamlik waargenome bevorderaars van optimale benutting van fasiliteit-gebaseerde moedergesondheidsorgdienste, waargenome belemmerings van die benutting van hierdie dienste, en deelnemers se voorstelle vir die verbetering van fasiliteit-gebaseerde moedergesondheidsdiensbenutting. Bevorderaars het goeie moedergesondheidsorgdienste, gesin- en eggenoot-ondersteuning, omvattende dienste onder een dak, en goeie opvoeding, berading en advies ingesluit. Die bevindinge het gewys dat belemmerings kulturele praktyke, gesinsmagsverhoudinge en -besluitneming, godsdienstige oortuigings, afstand na gesondheidsfasiliteite, vertroue in tradisionele geboorteverpleërs, vrees vir toetsing vir MIV, gesondheidswerkers se houdings,tekort aan personeel, onvoldoende fisiese infrastruktuur, en onvoldoende mediese toerusting, voorrade en medisyne insluit. Voorstelle is gemaak om die beskikbaarheid van mediese voorrade, mediese toerusting en ambulanse te verseker; personeelprobleme soos personeeltekorte en swak houding teenoor pasiënte op te los; gesondheidsopvoeding/inligting aan die gemeenskap te beklemtoon; en fisiese infrastruktuur op te gradeer. Die studieresultate is geëvalueer deur ’n SWOT-analise te gebruik om strategieë te ontwikkel vir die bevordering van optimale benutting van fasiliteit-gebaseerde moedergesondheidsorgdienste. Die bevindinge dui daarop dat fasiliteit-gebaseerde moedergesondheidsorgdienste oor die algemeen binne die gemeenskap gebruik word. Vir optimale benutting moet die geïdentifiseerde bevorderaars egter versterk word en die belemmerings oorkom word. Voorgestelde strategieë is aangebied.

Ukunakekelwa kwezempilo komama kuhlanganisa izinsizakalo zokunakekelwa kwezempilo ezidluliselwa kwabesifazane ngesikhathi sokukhulelwa, ukubeletha, kanye nesikhathi sangemva kokubeletha. Ukungasetshenziswa kancane kwezinsiza zokunakekelwa kwezempilo komama, ikakhulukazi ngesikhathi sokubeletha nangemva kokubeletha, kuphambene nemizamo yokunciphisa ukushona komama kanye nokugula emhlabeni jikelele. Emazweni anemali engenayo emaphakathi nephansi, okuhlanganisa neTanzania, abesifazane abaningi bahambela okungenani isikhathi esisodwa sokunakekelwa kwabakhulelwe, kodwa ngenxa yenqubomgomo yezempilo kanye nezizathu ezihlobene nenani labantu abambalwa kuphela abenza ukuxhumana okuphakanyisiwe okuyisishiyagalombili. Okunye futhi, abanye besifazane ababelethi ezikhungweni zezempilo futhi abaqhubeki nezinsiza ngemuva kokubeletha, ngoba abasiboni isidingo sokwenza lokho. Ucwaningo lwenzelwe ukuhlola imibono yomphakathi ngokusebenzisa izinsizakalo zokunakekelwa kwezempilo komama esikhungweni sase-Wete Pemba kanye nokusungula amasu okukhuthaza ukusetshenziswa ngendlela efanele. .Umklamo ochazayo osezingeni wasetshenziswa ukuze kutholwe imininingwane ngezingxoxiswano zabantu besifazane (n=16) namadoda (n=15), kanye nangezingxoxo ezine zamaqembu okugxilwe kuwo nabahlengikazi (n=19). Ukuqoqwa kwemininingwane kwenziwa kusetshenziswa inhlolokhono enesakhiwo esincane futhi imininingwane yahlaziywa ngokwengqikithi kusetshenziswa i-MAXQDA2020. Kwavela izindikimba ezintathu, okungabagqugquzeli bokusetshenziswa ngokugcwele kwezinsizakalo zokunakekelwa kwezempilo komama ezikhungweni, okucatshangwa ukuthi kubathiya ukusetshenziswa kwalezi zinsizakalo, kanye neziphakamiso zabahlanganyeli zokuthuthukisa ukusetshenziswa kwensizakalo yezempilo komama. Abagqugquzeli bahlanganisa nezinsizakalo ezinhle zokunakekelwa kwezempilo komama; ukwesekwa komndeni nomlingani; izinsizakalo ezibanzi ngaphansi kophahla olulodwa, kanye nemfundo enhle, ukwelulekwa, nezeluleko. Izithiyo kutholakale ukuthi imikhuba yamasiko, ubudlelwano bamandla omndeni nokuthathwa kwezinqumo, izinkolelo zezenkolo, ibanga lokuya ezikhungweni zezempilo, ukwethemba ababelethisi bendabuko, ukwesaba ukuhlolelwa igciwane lesandulela ngculazi, isimo sengqondo sochwepheshe bezempilo, ukushoda kwabasebenzi, ingqalasizinda engokomzimba eyanele, kanye nemishini yezokwelapha enganele kanye nokokusebenza, okuhlanganisa nemithi. Iziphakamiso bekuwukuthi: qinisekisa ukutholakala kwezinsiza zokwelapha, izinto zokwelashwa, nama-ambulensi; ukuxazulula izinkinga zabasebenzi njengokushoda kwabasebenzi kanye nesimo sengqondo esingesihle ngeziguli; gcizelela imfundo/ulwazi lwezempilo emphakathini; kanye nokuthuthukisa ingqalasizinda ebonakalayo. Imiphumela yocwaningo yahlolwa kusetshenziswa ukuhlaziya kwe-SWOT ukuze kwakhiwe amasu okukhuthaza ukusetshenziswa okuphelele kwezinsizakalo zokunakekelwa kwezempilo komama ezisekelwe esikhungweni. Imiphumela ikhomba ukuthi izinsizakalo zokunakekelwa kwezempilo komama ezisekelwe esikhungweni emphakathini zivame ukusetshenziswa. Kodwa-ke, ukuze kutholakale ukusetshenziswa okuphelele, abathuthukisi abahlonziwe badinga ukuqiniswa futhi kunqotshwe izithiyo. Amasu aphakanyisiwe ayethulwa.