Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data
Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data
Objectives: to investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.
Design: the study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.
Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.
Participants: women who gave birth in health facilities in the Eastern Region, Ghana in 2017.
Outcome measures: the count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.
Results: as travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.
Conclusions: so increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
epidemiology, health policy, maternal medicine, public health
e066792
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
18 January 2023
Dotse-Gborgbortsi, Winfred
02d3e356-268e-4650-9fb9-9638ccdb6eff
Tatem, Andrew
6c6de104-a5f9-46e0-bb93-a1a7c980513e
Matthews, Zoe
ebaee878-8cb8-415f-8aa1-3af2c3856f55
Alegana, Victor A.
17871690-1cac-4acd-9371-31c71cded2f4
Ofosu, Anthony
32461b6f-8de7-4289-bd29-923f9f042d53
Wright, Jim
94990ecf-f8dd-4649-84f2-b28bf272e464
Dotse-Gborgbortsi, Winfred, Tatem, Andrew, Matthews, Zoe, Alegana, Victor A., Ofosu, Anthony and Wright, Jim
(2023)
Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data.
BMJ Open, 13 (1), , [e066792].
(doi:10.1136/bmjopen-2022-066792).
Abstract
Objectives: to investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.
Design: the study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.
Setting: 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.
Participants: women who gave birth in health facilities in the Eastern Region, Ghana in 2017.
Outcome measures: the count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.
Results: as travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.
Conclusions: so increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
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More information
Accepted/In Press date: 5 January 2023
Published date: 18 January 2023
Additional Information:
Funding Information:
The study was funded by the Economic and Social Research Council (ESRC), UK (grant number ES/P000673/1) through the South Coast Doctoral Training Partnership.
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords:
epidemiology, health policy, maternal medicine, public health
Identifiers
Local EPrints ID: 474508
URI: http://eprints.soton.ac.uk/id/eprint/474508
ISSN: 2044-6055
PURE UUID: 08bc0aef-ec52-431b-9d01-53876a1cd842
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Date deposited: 23 Feb 2023 17:40
Last modified: 10 Apr 2024 02:12
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Author:
Winfred Dotse-Gborgbortsi
Author:
Victor A. Alegana
Author:
Anthony Ofosu
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