The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana

Abstract

ObjectivesSkilled birth attendance is the single most important intervention to reduce maternal mortality. However, studies have not used routinely collected health service birth data at named health facilities to understand the influence of distance and quality of care on childbirth service utilisation. Thus, this paper aims to quantify the influence of distance and quality of healthcare on utilisation of birthing services using routine health data in Eastern Region, Ghana.MethodsWe used a spatial interaction model (a model that predicts movement from one place to another) drawing on routine birth data, emergency obstetric care surveys, gridded estimates of number of pregnancies and health facility location. We compared travel distances by sociodemographic characteristics and mapped movement patterns.ResultsA kilometre increase in distance significantly reduced the prevalence rate of the number of women giving birth in health facilities by 6.7%. Although quality care increased the number of women giving birth in health facilities, its association was insignificant. Women travelled further than expected to give birth at facilities, on average journeying 4.7 km beyond the nearest facility with a recorded birth. Women in rural areas travelled 4 km more than urban women to reach a hospital. We also observed that 56% of women bypassed the nearest hospital to their community.ConclusionThis analysis provides substantial opportunities for health planners and managers to understand further patterns of skilled birth service utilisation, and demonstrates the value of routine health data. Also, it provides evidence-based information for improving maternal health service provision by targeting specific communities and health facilities.

Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana

“…Consequently, higher health services utilization in rural locations is not always a function of improved healthcare delivery system but a reflection of lack of choice for better alternatives. Indeed, other barriers to MNCH service utilization not explored in this study are acknowledged in terms of long travel times to health facilities [24,26,29], socio-cultural beliefs [16,23,30,31] and financial inaccessibility [32][33][34][35][36][37].…”

“…Density of midwives and other frontline health staff significantly correlated with number of ANC visits recorded in the study health facilities over the three-year period, contrary to findings by similar studies on Ghana [9,18,19] and other countries [20,21], which reported that the number of frontline health workers per se did not enhance utilization of maternal and child health services. These studies argue that poor attitudes of staff and other health system challenges remain important constraints to utilization of maternal, newborn and child health (MNCH) services in Ghana [16,[22][23][24][25][26][27][28][29][30].…”

The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria

“…The journey origin and health facility used were clearly defined, and geographic coordinates were available to measure proximity compared with limitations in similar studies [ 46 ]. We avoided the assumption in DHS survey data analysis that women use the health facility closest to their residence [ 12 ], as there is evidence of large variations in expected (nearest health facility) and observed patterns of using birthing services in health facilities [ 47 ]. Our geospatial analysis also eliminated errors associated with self-reported distance and recall bias in other studies [ 37 ].…”

Postnatal care utilisation among women in rural Ghana: analysis of 2014 Ghana demographic and health survey

“…The 2014 Ghana Demographic and Health Survey (GDHS) indicated that 74% of mothers living in rural areas were least probable to receive early postnatal check-up relative to other subgroups. Women in rural areas of Ghana travel 4 km more than urban women to reach a hospital [ 17 ]. The same study indicated that a kilometre increase in distance significantly reduces maternal healthcare utilisation [ 17 ].…”

“…Women in rural areas of Ghana travel 4 km more than urban women to reach a hospital [17]. The same study indicated that a kilometre increase in distance significantly reduces maternal healthcare utilisation [17]. Additionally, it is known that the distribution of health facilities is skewed towards urban centres in Ghana [18].…”