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Access to Maternal Health in Regions of Rwanda: A Qualitative Study

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Practicing Health Geography

Part of the book series: Global Perspectives on Health Geography ((GPHG))

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Abstract

Access to health care is essential to achieving the best health outcomes. In this chapter, I highlight the structural, geographical, social-cultural and economic factors that act as facilitators or barriers to accessing maternal health services at the community level in Rwanda. Using five dimensions of access to health care (availability, accessibility, accommodation, affordability and acceptability), I qualitatively explore community dynamics pertaining to women’s access to community maternal health services in both rural and urban settings. I also examine the role of volunteer community health workers, who are elected by their own communities to provide maternal health services to women, and link communities to the formal health care system.

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References

  • AbouZahr, C. (2014). Progress and challenges in women’s health: An analysis of levels and patterns of mortality and morbidity. Contraception, 90(6), S3–S13. https://doi.org/10.1016/j.contraception.2014.03.007.

    Article  Google Scholar 

  • Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A. B., Gemmill, A., et al. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462–474.

    Article  Google Scholar 

  • Arku, G., Mkandawire, P., Luginaah, I., & Baiden, P. (2013). Healthcare access in three residential neighborhoods in Accra, Ghana. In Spatial inequalities (pp. 191–204). Dordrecht: Springer.

    Chapter  Google Scholar 

  • Atuoye, K. N., Dixon, J., Rishworth, A., Galaa, S. Z., Boamah, S. A., & Luginaah, I. (2015). Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana. BMC Health Services Research, 15(1), 333.

    Article  Google Scholar 

  • Babalola, S., & Fatusi, A. (2009). Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors. BMC Pregnancy and Childbirth, 9(1), 43.

    Article  Google Scholar 

  • Berry, N. S. (2009). Making pregnancy safer for women around the world: the example of safe motherhood and maternal death in Guatemala. See Hahn & Inhorn, 2009, 422–46.

    Google Scholar 

  • Bongaarts, J. (2016). WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population division trends in maternal mortality: 1990 to 2015. Geneva: World Health Organization, 2015. Population and Development Review, 42(4), 726.

    Google Scholar 

  • Ditekemena, J., Koole, O., Engmann, C., Matendo, R., Tshefu, A., Ryder, R., & Colebunders, R. (2012). Determinants of male involvement in maternal and child health services in sub-Saharan Africa: A review. Reproductive Health, 9(1), 32.

    Article  Google Scholar 

  • Evans, D. B., Hsu, J., & Boerma, T. (2013). Universal health coverage and universal access. Bulletin of the World Health Organization, 91(8), 546–546A.

    Article  Google Scholar 

  • Filippi, V., Ronsmans, C., Campbell, O. M., Graham, W. J., Mills, A., Borghi, J., et al. (2006). Maternal health in poor countries: The broader context and a call for action. The Lancet, 368(9546), 1535–1541.

    Article  Google Scholar 

  • Finlayson, K., & Downe, S. (2013). Why do women not use antenatal services in low-and middle-income countries? A meta-synthesis of qualitative studies. PLoS Medicine, 10(1), e1001373.

    Article  Google Scholar 

  • Fotso, J. C., Ezeh, A., & Oronje, R. (2008). Provision and use of maternal health services among urban poor women in Kenya: What do we know and what can we do? Journal of Urban Health, 85(3), 428–442.

    Article  Google Scholar 

  • Fotso, J. C., Ezeh, A., Madise, N., Ziraba, A., & Ogollah, R. (2009). What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Maternal and Child Health Journal, 13(1), 130–137.

    Article  Google Scholar 

  • Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., & Hudson, M. (2002). What does ‘access to health care’ mean? Journal of Health Services Research & Policy, 7(3), 186–188.

    Article  Google Scholar 

  • Joharifard, S., Rulisa, S., Niyonkuru, F., Weinhold, A., Sayinzoga, F., Wilkinson, J., et al. (2012). Prevalence and predictors of giving birth in health facilities in Bugesera District, Rwanda. BMC Public Health, 12(1), 1049–1058.

    Article  Google Scholar 

  • Kearns, R. A. (1993). Place and health: towards a reformed medical geography. The Professional Geographer, 45(2), 139–147.

    Google Scholar 

  • Khan, A. A., & Bhardwaj, S. M. (1994). Access to health care: A conceptual framework and its relevance to health care planning. Evaluation and the Health Professions, 17(1), 60–76.

    Article  Google Scholar 

  • Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. F. (2006). WHO analysis of causes of maternal death: a systematic review. The Lancet, 367(9516), 1066–1074.

    Google Scholar 

  • Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12(1), 18.

    Article  Google Scholar 

  • Makanga, P. T., Schuurman, N., Sacoor, C., Boene, H. E., Vilanculo, F., Vidler, M., et al. (2017). Seasonal variation in geographical access to maternal health services in regions of southern Mozambique. International Journal of Health Geographics, 16(1), 1.

    Article  Google Scholar 

  • McTavish, S., Moore, S., Harper, S., & Lynch, J. (2010). National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa. Social Science & Medicine, 71(11), 1958–1963.

    Article  Google Scholar 

  • Påfs, J., Musafili, A., Binder-Finnema, P., Klingberg-Allvin, M., Rulisa, S., & Essén, B. (2015). ‘They would never receive you without a husband’: Paradoxical barriers to antenatal care scale-up in Rwanda. Midwifery, 31(12), 1149–1156.

    Article  Google Scholar 

  • Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care, 19, 127–140.

    Article  Google Scholar 

  • Raven, J., Akweongo, P., Baba, A., Baine, S. O., Sall, M. G., Buzuzi, S., & Martineau, T. (2015). Using a human resource management approach to support community health workers: Experiences from five African countries. Human Resources for Health, 13(1), 45.

    Article  Google Scholar 

  • Ricketts, T. C. (2009). Accessing health care. A Companion to health and medical geography, 521–539.

    Google Scholar 

  • Rosen, H. E., Lynam, P. F., Carr, C., Reis, V., Ricca, J., Bazant, E. S., & Bartlett, L. A. (2015). Direct observation of respectful maternity care in five countries: A cross-sectional study of health facilities in east and southern Africa. BMC Pregnancy and Childbirth, 15(1), 306.

    Article  Google Scholar 

  • Saurman, E. (2016). Improving access: Modifying Penchansky and Thomas’s theory of access. Journal of Health Services Research & Policy, 21(1), 36–39.

    Article  Google Scholar 

  • Schuurman, N. (2009). Chapter 4: The effects of population density, physical distance and socio-economic vulnerability on access to primary health care in rural and remote British Columbia, Canada. In Primary health care: People, practice, place (pp. 57–74). Farnham: Ashgate.

    Google Scholar 

  • Singh, P., & Sachs, J. D. (2013). 1 million community health workers in sub-Saharan Africa by 2015. The Lancet, 382(9889), 363–365.

    Article  Google Scholar 

  • Tey, N. P., & Lai, S. L. (2013). Correlates of and barriers to the utilization of health services for delivery in South Asia and sub-Saharan Africa. The Scientific World Journal, 2013, 1.

    Article  Google Scholar 

  • Tuyisenge, G., Hategeka, C., Kasine, Y., Luginaah, I., Cechetto, D., & Rulisa, S. (2019). Mothers’ perceptions and experiences of using maternal health care services in Rwanda. Women & Health, 59, 68–84.

    Article  Google Scholar 

  • Ward, B., Humphreys, J., McGrail, M., Wakerman, J., & Chisholm, M. (2015). Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care? Australian Health Review, 39(2), 121–126.

    Article  Google Scholar 

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Tuyisenge, G. (2021). Access to Maternal Health in Regions of Rwanda: A Qualitative Study. In: Makanga, P.T. (eds) Practicing Health Geography. Global Perspectives on Health Geography. Springer, Cham. https://doi.org/10.1007/978-3-030-63471-1_8

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  • DOI: https://doi.org/10.1007/978-3-030-63471-1_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-63470-4

  • Online ISBN: 978-3-030-63471-1

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