Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: findings from a qualitative study

Abstract

Background COVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored. The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria. Methods A qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. Results Barriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services. Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics. Conclusion Access to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients’ ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models.

An Integrative Literature Review on the Impact of COVID-19 on Maternal Health in Africa

“…Additionally, the pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources -particularly PPE, and lack of suitable training of personnel. The needed shift of resources to caring for very ill COVID patients meant fewer resources for pregnant and labouring women [34,47]. Recommendations to deal with epidemic related issues in the future include a need to develop plans ahead of time, methods to limit exposure of health personnel through adequate training in the use of PPE and adequate availability of PPE but also conserving PPE to be used only when needed [47].…”

“…Lack of adequate sta ng was due to a combination of lack of personnel out sick due to COVID or concerns about contacting the disease [34,36] and lockdown effects of limiting transportation and economic activity. This resulted in lack of preparedness by health workers, prioritization of essential services, and long wait times at the hospitals all of which were identi ed as barriers to accessing maternal, newborn and child health services during the rst wave of COVID-19 [34].…”

“…Several studies speci cally cited women's concerns about the lack of PPE for both patients and staff [14,33]. A Nigerian qualitative study identi ed barriers to accessing MHC included both women's concerns about lack of PPE and shortage of manpower [34]. Interestingly, a study from Southwest Ethiopia among 402 pregnant women identi ed important delays in seeking care but fear of contagion or other aspects of the pandemic were not among them [35].…”

“…Lack of adequate sta ng was due to a combination of lack of personnel out sick due to COVID or concerns about contacting the disease [34,36] and lockdown effects of limiting transportation and economic activity. This resulted in lack of preparedness by health workers, prioritization of essential services, and long wait times at the hospitals all of which were identi ed as barriers to accessing maternal, newborn and child health services during the rst wave of COVID-19 [34]. Similarly mixed method study among skilled healthcare providers in six referral hospitals in Guinea, Nigeria, Tanzania, and Uganda to assesses how maternal healthcare was rendered identi ed inadequate knowledge about COVID-19, lack of infection prevention and control training, and di culties reaching workplace as barriers in providing MHC services [37].…”

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa

“…Ethiopia [ 21 ] Assess the magnitude of delays in maternal health service utilization and its associated factors among pregnant women in the Ilubabor zone during the COVID-19 pandemic Facility-based cross-sectional study February–April 2021 402 pregnant women Remarkable section of women experienced delays in seeking care with various factors, yet these delays were not related to pandemic fears. Akaba G., Dirisu O., Okunade K., et al 2022 Nigeria [ 22 ] Explore the barriers and facilitators of access to MNCH services during the first wave of covid-19 pandemic in Nigeria Qualitative May–July 2020 54 study participants (service users, service providers and policymakers,) Lack of PPE, shortage of manpower, long waiting times at the hospitals, prioritization of essential services, and lack of preparedness by health workers, were barriers to accessing MNCH services during the first wave of COVID-19. Enablers to access: COVID-19 preventive measures, community sensitization, and alternative strategies for administering immunization service at the clinics.…”