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1.
Introduction
High maternal and infant mortality continue to be major challenges to the attainment of the Millennium Development Goals for many low and middle-income countries. There is now evidence that voucher initiatives can increase access to maternal health services. However, a dearth of knowledge exists on the cost implications of voucher schemes. This paper estimates the incremental costs of a demand and supply side intervention aimed at increasing access to maternal health care services.Methods
This costing study was part of a quasi-experimental voucher study conducted in two districts in Eastern Uganda to explore the impact of demand and supply - side incentives on increasing access to maternal health services. The provider’s perspective was used and the ingredients approach to costing was employed. Costs were based on market prices as recorded in program records. Total, unit, and incremental costs were calculated.Results
The estimated total financial cost of the intervention for the one year of implementation was US$525,472 (US$1 = 2200UgShs). The major cost drivers included costs for transport vouchers (35.3%), health system strengthening (29.2%) and vouchers for maternal health services (18.2%). The average cost of transport per woman to and from the health facility was US$4.6. The total incremental costs incurred on deliveries (excluding caesarean section) was US$317,157 and US$107,890 for post natal care (PNC). The incremental costs per additional delivery and PNC attendance were US$23.9 and US$7.6 respectively.Conclusion
Subsidizing maternal health care costs through demand and supply – side initiatives may not require significant amounts of resources contrary to what would be expected. With Uganda’s Gross Domestic Product (GDP) per capita of US$55` (2012), the incremental cost per additional delivery (US$23.9) represents about 5% of GDP per capita to save a mother and probably her new born. For many low income countries, this may not be affordable, yet reliance on donor funding is often not sustainable. Alternative ways of raising additional resources for health must be explored. These include; encouraging private investments in critical sectors such as rural transport, health service provision; mobilizing households to save financial resources for preparedness, and financial targeting for the most vulnerable.2.
Pariyo G Serwadda D Sewankambo NK Groves S Bollinger RC Peters DH 《BMC international health and human rights》2011,11(Z1):S2
Background
“Grand challenges” in global health have focused on discovery and development of technologies to save lives. The “grander challenge” involves building institutions, systems, capacity and demand to effectively deliver strategies to improve health. In 2008, Makerere University began a radical institutional change to bring together four schools under one College of Health Sciences. This paper’s objective is to demonstrate how its leadership in training, research, and services can improve health in Uganda and internationally, which lies at the core of the College’s vision.Methods
A comprehensive needs assessment involved five task forces that identified MakCHS’s contribution to the Ugandan government health priorities. Data were collected through analysis of key documents; systematic review of MakCHS publications and grants; surveys of patients, students and faculty; and key informant interviews of the College’s major stakeholders. Four pilot projects were conducted to demonstrate how the College can translate research into policy and practice, extend integrated outreach community-based education and service, and work with communities and key stakeholders to address their priority health problems.Results
MakCHS inputs to the health sector include more than 600 health professionals graduating per year through 23 degree programs, many of whom assume leadership positions. MakCHS contributions to processes include strengthened approaches to engaging communities, standardized clinical care procedures, and evidence-informed policy development. Outputs include the largest number of outpatients and inpatient admissions in Uganda. From 2005-2009, MakCHS also produced 837 peer-reviewed research publications (67% in priority areas). Outcomes include an expanded knowledge pool, and contributions to coverage of health services and healthy behaviors. Impacts include discovery and applications of global significance, such as the use of nevirapine to prevent HIV transmission in childbirth and male circumcision for HIV prevention. Pilot projects have applied innovative demand and supply incentives to create a rapid increase in safe deliveries (3-fold increase after 3 months), and increased quality and use of HIV services with positive collateral improvements on non-HIV health services at community clinics.Conclusion
MakCHS has made substantial contributions to improving health in Uganda, and shows great potential to enhance this in its new transformational role – a model for other Universities.3.
Kizza IB Tugumisirize J Tweheyo R Mbabali S Kasangaki A Nshimye E Sekandi J Groves S Kennedy CE 《BMC international health and human rights》2011,11(Z1):S7
Background
Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.Methods
Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.Results
Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.Conclusions
Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.4.
Okui O Ayebare E Chalo RN Pariyo GW Groves S Peters DH 《BMC international health and human rights》2011,11(Z1):S14
Background
Partnerships and networking are important for an institution of higher learning like Makerere University College of Health Sciences (MakCHS) to be competitive and sustainable.Methods
A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of MakCHS to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes.Results
The College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. Many stakeholders felt that the initiative for collaboration currently came more from the stakeholders than the College. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also identified the opportunity for MakCHS to embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. The need for MakCHS to be more vigorous in training to enhance professionalism and ethical conduct was also identified.Discussion
As a constituent of a public university, MakCHS has relied on public funding, which has been inadequate to fulfill its mission. Broader networking, marketing to mobilize resources, and providing strong leadership and management support to inspire confidence among its current and potential stakeholders will be essential to MakCHS’ further growth. MakCHS’ relevance is hinged on generating research knowledge for solving the country’s contemporary health problems and starting relevant programs and embracing technologies. It should share new knowledge widely through publications and other forms of dissemination. Whether institutional leadership is best in the hands of academicians or professional managers is a debatable matter.Conclusions
This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance, and sustainability. Conducting stakeholder and sustainability analyses are instructive toward this end, and have provided information and perspectives on how to make long-range informed choices for success.5.
6.
Yacobou Sanoussi 《BMC health services research》2017,17(2):699
Background
Access to maternal and child health care in low- and middle-income countries such as Togo is characterized by significant inequalities. Most studies in the Togolese context have examined the total inequality of health and the determinants of individuals’ health. Few empirical studies in Togo have focused on inequalities of opportunity in maternal and child health. To fill this gap, we estimated changes in inequality of opportunity in access to maternal and child health services between 1998 and 2013 using data from Togo Demographic and Health Surveys (DHS).Method
We computed the Human Opportunity Index (HOI)—a measure of how individual, household, and geographic characteristics like sex and place of residence can affect individuals’ access to services or goods that should be universal—using five indicators of access to healthcare and one composite indicator of access to adequate care for children. The five indicators of access were: birth in a public or private health facility; whether the child had received any vaccinations; access to prenatal care; prenatal care given by qualified staff; and having at least four antenatal visits. We then examined differences across the two years.Results
Between 1998 and 2013, inequality of opportunities decreased for four out of six indicators. However, inequalities increased in access to antenatal care provided by qualified staff (5.9% to 12.5%) and access to adequate care (27.7% to 28.6%).Conclusions
Although inequality of opportunities reduced between 1998 and 2013 for some of the key maternal and child health indicators, the average coverage and access rates underscore the need for sustained efforts to ensure equitable access to primary health care for mothers and children.7.
Nkechi S. Owoo Monica Puoma Lambon-Quayefio Nicole Amara Onuoha 《Zeitschrift fur Gesundheitswissenschaften》2017,25(5):557-564
Aim
Caesarean section deliveries in Ghana increased from 6 to 13% between 2008 and 2014. This current rate is dangerously close to the safe limit suggested by the World Health Organisation (WHO) and is particularly concerning in the absence of a negative correlation between the rising CS rates and neonatal mortality in the country. The research therefore examines the factors correlated with caesarean section delivery in Ghana, with an aim to making research-based policy suggestions to curb the observed trends.Subjects and methods
The 2014 Ghana Demographic and Health Survey is employed for the analysis, and a probit model is used to examine the effects of demographic and socioeconomic factors, maternal leave policy and government health institutions on the likelihood of caesarean section deliveries in Ghana. The analysis uses the last births of 1284 women of childbearing age in the country.Results
The results indicate that demographic and socioeconomic factors are important determinants of caesarean section deliveries. While antenatal care attendance at government institutions reduces the likelihood of caesarean section, deliveries in government health facilities are more likely to be done by caesarean section. Interestingly, women with previous pregnancy complications are not significantly more likely to have a caesarean section delivery. This might indicate that many caesarean sections performed in the country may be elective and not necessarily medically necessary.Conclusions
Child and maternal survivals are often given as justifications for caesarean section deliveries. The absence of a negative relationship between increasing caesarean section rates and neonatal mortality in the country therefore creates some concern.8.
Ligia Paina Lalitha Vadrevu S. M. Manzoor Ahmed Hanifi Joseph Akuze Rachel Rieder Kitty S. Chan David H. Peters 《BMC health services research》2016,16(7):621
Background
While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.Methods
We developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression), as well as sub-national level effects (using a mixed effects model).Results
Our final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman’s odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %.Conclusion
Individual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be taken into account when designing programs and interventions to support institutional deliveries. Consideration of individual factors and the capabilities of the communities in which people live would contribute to the vision of supporting people-centered approaches to health.9.
Pariyo GW Mayora C Okui O Ssengooba F Peters DH Serwadda D Lucas H Bloom G Rahman MH Ekirapa-Kiracho E 《BMC international health and human rights》2011,11(Z1):S10
Background
Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.Objectives
To explore the use of intermediate transport mechanisms to improve access to maternal health services, with emphasis on the benefits and unintended consequences of the transport scheme, as well as challenges in the implementation of the scheme.Methods
This paper is based on the pilot phase to inform a quasi experimental study aimed at increasing access to maternal health services using demand and supply side incentives. The data collection for this paper included qualitative and quantitative methods that included focus group interviews, review of project documents and facility level data.Results
There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilizing mothers to attend services. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations.Conclusions and implications
The findings indicate that locally existing resources such as motorcycle riders, also known as “boda boda” can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilization of maternal health services. However, care must be taken to mobilize the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.10.
Kiguli S Baingana R Paina L Mafigiri D Groves S Katende G Kiguli-Malwadde E Kiguli J Galukande M Roy M Bollinger R Pariyo G 《BMC international health and human rights》2011,11(Z1):S3
Background
Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major reform to become a more influential force in society. It is important that its medicine and nursing graduates are equipped to best address the priority health needs of the Ugandan population, as outlined in the government’s Health Sector Strategic Plan (HSSP). The assessment identifies critical gaps in the core competencies of the MakCHS medicine and nursing and ways to overcome them in order to achieve HSSP goals.Methods
Documents from the Uganda Ministry of Health were reviewed, and medicine and nursing curricula were analyzed. Nineteen key informant interviews (KII) and seven focus group discussions (FGD) with stakeholders were conducted. The data were manually analyzed for emerging themes and sub-themes. The study team subsequently used the checklists to create matrices summarizing the findings from the KIIs, FGDs, and curricula analysis. Validation of findings was done by triangulating information from the different data collection methods.Results
The core competencies that medicine and nursing students are expected to achieve by the end of their education were outlined for both programs. The curricula are in the process of reform towards competency-based education, and on the surface, are well aligned with the strategic needs of the country. But implementation is inadequate, and can be changed:? Learning objectives need to be more applicable to achieving competencies.? Learning experiences need to be more relevant for competencies and setting in which students will work after graduation (i.e. not just clinical care in a tertiary care facility).? Student evaluation needs to be better designed for assessing these competencies.Conclusion
MakCHS has made a significant attempt to produce relevant, competent nursing and medicine graduates to meet the community needs. Ways to make them more effective though deliberate efforts to apply a competency-based education are possible.11.
Background
Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal.Methods
This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women’s background characteristics.Results
Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR?=?1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR?=?1.44; 95% CI: 1.18-1.77) and delivery services (OR?=?1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs.Conclusions
Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women’s knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal’s health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.12.
Ling Zhang Chengbing Xue Youjie Wang Liuyi Zhang Yuan Liang 《Asia Pacific family medicine》2016,15(1):5
Background and objectives
Despite the benefits of maternal health services, these services are often underutilized, especially in the developing countries. The aim of the present study is to provide insight regarding factors affecting maternal health services use from the family perspective.Methods
We use data from the fourth National Health Services Survey in Jiangsu province of Eastern China to investigate the effect of family characteristics on the use of maternal health services. Family characteristics included whether or not living with parents, age of husband, husband’s education, and husband’s work status as well as family economic status. Demographic variables, social and environmental factors, and previous reproductive history were taken as potential confounders. Multiple logistic regression models were used to examine the independent effects of the family characteristic variables on maternal health service utilization.Results
The data indicate that the percentages of prenatal care, postnatal visits and hospital delivery were 85.44, 65.12 and 99.59 % respectively. Living with parents was associated with less use of prenatal care and husband’s age, education and employment status had no effect on the use of prenatal care after adjusting for potential confounding variables.Conclusions
Our findings suggest that maternal health education (especially the role of prenatal care) needs to be extended beyond the expectant mothers themselves to their parents and husbands. The difference of health care delivery as a result of traditional family culture may highlight the differences in factors influencing the use of postnatal visits and those influencing the use of prenatal care; which may be worthy of further study.13.
Sylviana Haji Moris Orla Carty Kristina L. Wanyonyi Jennifer E. Gallagher 《Zeitschrift fur Gesundheitswissenschaften》2017,25(6):601-610
Objective
To evaluate patients’ views on health service initiatives established to improve uptake of NHS primary dental care amongst adult patients in a socially deprived area, comparing practices with extended and regular contract capacity.Study design
Service evaluation and cross-sectional survey.Method
Questionnaire survey of patients attending a random sample of dental practices in three inner-metropolitan boroughs of south London following initiatives to improve access to dental care (across dental practices delivering regular and extended contracts for services) exploring attendance patterns and the influence and awareness of local initiatives to promote access.Results
Four hundred fifty adults across 12 dental practices completed questionnaires: 79% reported attending for routine and 21% for urgent care. Patients were most aware of banners outside practices, followed by dental advertisements in newspapers. Vouchers for free treatments were considered of the highest possible influence, followed by vouchers for reduced treatment costs and an emergency out-of-hours helpline. Awareness and influence were not aligned, and there was no evidence of difference by practice contract type whilst there were differences by age and type of attendance.Conclusion
The findings suggest that financial incentives and emergency services are considered the most influential initiatives for adult patients whose attendance patterns appear to be related to personal circumstances rather than merely being influenced by the provision of information.14.
Hooman Shahsavari Alireza Nikbakht Nasrabadi Mohammad Almasian Heshmatolah Heydari Abdolrahim Hazini 《Asia Pacific family medicine》2018,17(1):1
Background
Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task.Objectives
The purpose of this study was to explore the administrative aspects of the delivery of home health care services.Methods
This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method.Results
23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories.Conclusion
Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.15.
Background
The benefits of maternal health care to maternal and neonatal health outcomes have been well documented. Antenatal care attendance, institutional delivery and skilled attendance at delivery all help to improve maternal and neonatal health. However, use of maternal health services is still very low in developing countries with high maternal mortality including Ethiopia. This study examines the association of unintended Pregnancy with the use of maternal health services in Southwestern Ethiopia.Methods
Data for this study come from a survey conducted among 1370 women with a recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern Ethiopia. An interviewer administered questionnaire was used to gather data on maternal health care, pregnancy intention and other explanatory variables. Data were analyzed using STATA 11, and both bivariate and multivariate analyses were done. Multivariate logistic regression was used to assess the association of pregnancy intention with the use of antenatal and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported.Results
More than one third ( 35%) of women reported that their most recent pregnancy was unintended. With regards to maternal health care, only 42% of women made at least one antenatal care visit during pregnancy, while 17% had four or more visits. Institutional delivery was only 12%. Unintended pregnancy was significantly (OR: 0.75, 95% CI, 0.58-0.97) associated with use of antenatal care services and receiving adequate antenatal care (OR: 0.67, 95% CI, 0.46-0.96), even after adjusting for other socio-demographic factors. However, for delivery care, the association with pregnancy intention was attenuated after adjustment. Other factors associated with antenatal care and delivery care include women’s education, urban residence, wealth and distance from health facility.Conclusions
Women with unintended pregnancies were less likely to access or receive adequate antenatal care. Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women’s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care.16.
17.
Muhammad Ashraf Majrooh Seema Hasnain Javaid Akram Arif Siddiqui 《Health research policy and systems / BioMed Central》2015,13(Z1):S59
Background
There are two types of barriers to the utilisation of maternal health and antenatal care (ANC) services, including the supply-side barriers operating at the health facility level and demand-side, affecting the utilisation ANC services by pregnant women. The purpose of the study was to assess the essential resources required for the provision of ANC services in primary healthcare facilities in Punjab, Pakistan.Methods
A cross-sectional facility assessment was conducted in primary healthcare facilities across Punjab. A multi-stage sampling was used to randomly select nine districts from three stratifications and 19 primary healthcare facilities in the public sector (17 Basic Health Units (BHUs) and two Rural Health Centres (RHCs)) from each district. A total of 171 health facilities were included. Data on infrastructure and availability of equipment, essential supplies, medicines, treatment protocols, and infection control items was collected through pre-tested, semi-structured questionnaires. Univariate analysis was carried out to describe the frequency and percentages of facilities across three ratings (good, average, and poor) by type of facility.Results
Overall, 28% of facilities had poor infrastructure and the availability of equipment was poor in 16% of the health facilities. Essential supply items, such as urine strips for albumin, blood sugar testing strips, and haemoglobin reagents, were particularly poorly stocked. However, infrastructure and the availability of equipment and supplies were generally better in RHCs compared to BHUs.Conclusion
Health facilities lacked the resources required to provide quality ANC services, particularly in terms of infrastructure, equipment, supply items, and medicines. The availability of these resources needs to be urgently addressed.18.
Background
A human rights approach to maternal health is considered as a useful framework in international efforts to reduce maternal mortality. Although fundamental human rights principles are incorporated into legal and medical frameworks, human rights have to be translated into measurable actions and outcomes. So far, their substantive applications remain unclear. The aim of this study is to explore women’s perspectives and experiences of maternal health services through a human rights perspective in Magu District, Tanzania.Methods
This study is a qualitative exploration of perspectives and experiences of women regarding maternity services in government health facilities. The point of departure is a Human Rights perspective. A total of 36 semi-structured interviews were held with 17 women, between the age of 31 and 63, supplemented with one focus group discussion of a selection of the interviewed women, in three rural villages and the town centre in Magu District. Data analysis was performed using a coding scheme based on four human rights principles: dignity, autonomy, equality and safety.Results
Women’s experiences of maternal health services reflect several sub-standard care factors relating to violations of multiple human rights principles. Women were aware that substandard care was present and described a range of ways how the services could be delivered that would venerate human rights principles. Prominent themes included: ‘being treated well and equal’, ‘being respected’ and ‘being given the appropriate information and medical treatment’.Conclusion
Women in this rural Tanzanian setting are aware that their experiences of maternity care reflect violations of their basic rights and are able to voice what basic human rights principles mean to them as well as their desired applications in maternal health service provision.19.
20.