Adequate utilization of services is critical to maximize the impact of understanding and addressing the factors responsible for access to reproductive health services, but little is known about factors affecting utilization.
The new strategy on Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Strategy 2017-2021, examined supply-and demand-side factors associated with the utilization as a bottleneck to access and utilise RMNCAH services.
The gaps and bottlenecks were identified through a review of the previous Reproductive Newborn and Child Health (RNCH) Strategy 2011-2015 and stakeholder consultations including three national workshops. Both demand and supply side barriers were identified as impacting access to and utilisation of high impact RMNCAH interventions.
According to the strategy the demand side barriers included socio-cultural practices, geographical and financial barriers. Despite the existence of the free health care initiative, review of literature and discussions with beneficiaries identified ‘under the table payments’ for provision of services limiting access especially by the most vulnerable.
“Adolescents do not have financial protection under the free health care initiative unless they are pregnant or lactating, therefore limiting their access to essential services. Other financial bottlenecks include lack of money to pay for transport to the health facilities resulting in delaying access to services. Some districts have inaccessible road networks while others are on islands creating geographical barriers to access…” the strategy adds.
Referencing the Sierra Leone Demographic Health Survey 2013 (SLDHS), out of the 76% of women who reported having had a barrier in accessing care; a leading number of them (67%) reported getting money to access treatment at health facility as the biggest barrier.
Other barriers reported included distance to health facilities (39%), getting permission to go to health facilities (18%) and not wanting to go alone (17%). Additionally, low male involved is also reported to result in poor access and utilization of services.
On the supply side barriers, were mainly health systems related bottlenecks which include: inadequate (numbers and skills), demotivated and mal-distributed human resources, unstable commodities and supplies, weak infrastructure, referrals, community and health information systems, as well as poor governance and coordination of the sector.
In response to the main causes of death for women, newborns, children and adolescents, eight intervention package areas have been prioritized. These are: family planning; antenatal care for positive experience in pregnancy; emergency obstetric and neonatal care including skilled birth attendance and essential newborn care; integrated management of newborn and childhood infections (IMCI) and integrated community case management of childhood illnesses (ICCM); immunization; nutrition; prevention of teenage pregnancy; and water, hygiene and sanitation (WASH).
The RMNCAH strategy has an objective of accelerating reduction of preventable deaths of women, children and adolescents and ensuring their health and wellbeing. This objective target is geared towards reducing maternal mortality ratio from 1,165 per 100,000 live births to 650 per 100,000 live births by 2021, neonatal mortality rate from 39 per 1,000 live births to 23 per 1,000 live births by 2021, under-five mortality rate from 156 deaths per 1,000 live births to 71 live births by 2021, Still birth rate from 24 per 1,000 live births to 18 per 1,000 live births by 2021 and adolescent birth rate from 125.1 to 74 per 1,000 women aged 15-19 years by 2021. ZJ/13/11/17
By Zainab Joaque
Tuesday November 14, 2017.
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