Skip to main content
Top
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana

Authors: Kilian Nasung Atuoye, Jenna Dixon, Andrea Rishworth, Sylvester Zackaria Galaa, Sheila A. Boamah, Isaac Luginaah

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

The Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS.

Methods

Using the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013.

Results

Lack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services.

Conclusion

These findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.
Literature
1.
go back to reference Cham M, Sundby J, Vangen S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005;2:3.CrossRefPubMedPubMedCentral Cham M, Sundby J, Vangen S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005;2:3.CrossRefPubMedPubMedCentral
2.
go back to reference Essien E, Ifenne D, Sabitu K, Musa A, Alti-Mu’azu M, Adidu V. Community loan funds and transport services for obstertric emergencies in Northern Nigeria. Int J Gynaecol Obstet. 1997;59:237–44.CrossRef Essien E, Ifenne D, Sabitu K, Musa A, Alti-Mu’azu M, Adidu V. Community loan funds and transport services for obstertric emergencies in Northern Nigeria. Int J Gynaecol Obstet. 1997;59:237–44.CrossRef
3.
go back to reference Leipziger D, Fay M, Wodon Q, Yepes T. Achieving the Millennium Development Goals: The Role of Infrastructure. 2003.CrossRef Leipziger D, Fay M, Wodon Q, Yepes T. Achieving the Millennium Development Goals: The Role of Infrastructure. 2003.CrossRef
4.
go back to reference Galaa S, Daare K. Understanding barriers to maternal child health services utilisation in northern Ghana. J Soc Dev Afr. 2008;23(2):127–55. Galaa S, Daare K. Understanding barriers to maternal child health services utilisation in northern Ghana. J Soc Dev Afr. 2008;23(2):127–55.
5.
go back to reference Buor D. Gender and the utilisation of health services in the Ashanti Region, Ghana. Health Policy. 2004;69(3):375–88.CrossRefPubMed Buor D. Gender and the utilisation of health services in the Ashanti Region, Ghana. Health Policy. 2004;69(3):375–88.CrossRefPubMed
6.
go back to reference World Health Organization: World Health Statistics: A Snapshot of Global Health. Geneva; 2012. World Health Organization: World Health Statistics: A Snapshot of Global Health. Geneva; 2012.
7.
go back to reference World Health Organization: World Health Statistics: A Wealth of Information on Global Public Health. Geneva; 2013. World Health Organization: World Health Statistics: A Wealth of Information on Global Public Health. Geneva; 2013.
8.
go back to reference Ministry of Health: Ministry of Health Ghana Holistic Assessment of the Health Sector Programme of Work 2013. Ghana: Accra; 2014. Ministry of Health: Ministry of Health Ghana Holistic Assessment of the Health Sector Programme of Work 2013. Ghana: Accra; 2014.
9.
go back to reference Macintyre K, Hotchkiss DR. Referral revisited: community financing schemes and emergency transport in rural Africa. Soc Sci Med. 1999;49:1473–87.CrossRefPubMed Macintyre K, Hotchkiss DR. Referral revisited: community financing schemes and emergency transport in rural Africa. Soc Sci Med. 1999;49:1473–87.CrossRefPubMed
10.
go back to reference Pattinson R, Kerber K, Buchmann E, Friberg IK, Belizan M, Lansky S, et al. Stillbirths: How can health systems deliver for mothers and babies? Lancet. 2011;377:1610–23.CrossRefPubMed Pattinson R, Kerber K, Buchmann E, Friberg IK, Belizan M, Lansky S, et al. Stillbirths: How can health systems deliver for mothers and babies? Lancet. 2011;377:1610–23.CrossRefPubMed
11.
go back to reference Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health. 2015;3(7):1–9.CrossRef Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health. 2015;3(7):1–9.CrossRef
12.
13.
go back to reference Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRefPubMed Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRefPubMed
14.
go back to reference Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, et al. Community-based situation analysis of maternal and neonatal care in South Africa to explore factors that impact utilization of maternal health services. J Midwifery Womens Health. 2007;52:342–50.CrossRefPubMed Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, et al. Community-based situation analysis of maternal and neonatal care in South Africa to explore factors that impact utilization of maternal health services. J Midwifery Womens Health. 2007;52:342–50.CrossRefPubMed
16.
go back to reference Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20:25–34.CrossRefPubMed Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20:25–34.CrossRefPubMed
17.
go back to reference Awoonor-williams JK, Bawah AA, Nyonator FK, Asuru R, Oduro A, Ofosu A, et al. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC Health Serv Res. 2013;13 Suppl 2:S3.CrossRefPubMedPubMedCentral Awoonor-williams JK, Bawah AA, Nyonator FK, Asuru R, Oduro A, Ofosu A, et al. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC Health Serv Res. 2013;13 Suppl 2:S3.CrossRefPubMedPubMedCentral
18.
go back to reference Dil Y, Strachan D, Cairncross S, Korkor AS, Hill Z. Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana. J Community Health. 2012;37:1192–8.CrossRefPubMed Dil Y, Strachan D, Cairncross S, Korkor AS, Hill Z. Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana. J Community Health. 2012;37:1192–8.CrossRefPubMed
19.
go back to reference Blaikie P, Brookfield H. Land Degradation and Society. London: Methuen; 1987. Blaikie P, Brookfield H. Land Degradation and Society. London: Methuen; 1987.
20.
21.
go back to reference Kalipeni E, Oppong J. The refugee crisis in Africa and implications for health and disease: a political ecology approach. Soc Sci Med. 1998;46:1637–53.CrossRefPubMed Kalipeni E, Oppong J. The refugee crisis in Africa and implications for health and disease: a political ecology approach. Soc Sci Med. 1998;46:1637–53.CrossRefPubMed
22.
go back to reference Richmond C, Elliott SJ, Matthews R, Elliott B. The political ecology of health: perceptions of environment, economy, health and well-being among’Namgis First Nation. Health Place. 2005;11:349–65.CrossRefPubMed Richmond C, Elliott SJ, Matthews R, Elliott B. The political ecology of health: perceptions of environment, economy, health and well-being among’Namgis First Nation. Health Place. 2005;11:349–65.CrossRefPubMed
23.
go back to reference Mkandawire P, Richmond C, Dixon J, Luginaah IN, Tobias J. Hepatitis B in Ghana’s upper west region: a hidden epidemic in need of national policy attention. Health Place. 2013;23:89–96.CrossRefPubMed Mkandawire P, Richmond C, Dixon J, Luginaah IN, Tobias J. Hepatitis B in Ghana’s upper west region: a hidden epidemic in need of national policy attention. Health Place. 2013;23:89–96.CrossRefPubMed
24.
go back to reference GSS, GHS, Macro ICF: Ghana Demographic and Health Survey 2008. Accra, Ghana; 2009 (Glss 5). GSS, GHS, Macro ICF: Ghana Demographic and Health Survey 2008. Accra, Ghana; 2009 (Glss 5).
25.
go back to reference GSS: National Population and Census, 2010. Accra; 2012 GSS: National Population and Census, 2010. Accra; 2012
26.
go back to reference Merriam J. Qualitative Research in Practice: Examples for Discussion and Analysis. San Francisco: Jossey-Bass; 2002. Merriam J. Qualitative Research in Practice: Examples for Discussion and Analysis. San Francisco: Jossey-Bass; 2002.
27.
go back to reference Guba EG, Lincoln YS. Competing paradigms in qualitative research: Theories and issues. In: Hesse-Biber SN, Patricia L, editors. Approaches to qualitative research: A reader on theory abd practice. Volume 18. New York: Oxford University Press, Inc; 2004. p. 17–38. Guba EG, Lincoln YS. Competing paradigms in qualitative research: Theories and issues. In: Hesse-Biber SN, Patricia L, editors. Approaches to qualitative research: A reader on theory abd practice. Volume 18. New York: Oxford University Press, Inc; 2004. p. 17–38.
28.
go back to reference Yin RK. Case Study Research: Design and Methods. 4th ed. Thousand Oaks, CA: Sage; 2009. Yin RK. Case Study Research: Design and Methods. 4th ed. Thousand Oaks, CA: Sage; 2009.
29.
go back to reference Maxwell JA. Designing a qualitative study. In: Bickman L, Rog DJ, editors. Qualitative Research. Thousand Oaks, CA: Sage; 2008. p. 214–53. Maxwell JA. Designing a qualitative study. In: Bickman L, Rog DJ, editors. Qualitative Research. Thousand Oaks, CA: Sage; 2008. p. 214–53.
30.
go back to reference Babbie E. The Basics of Social Research. 5th ed. Learning: Wadsworth Cengage; 2011. Babbie E. The Basics of Social Research. 5th ed. Learning: Wadsworth Cengage; 2011.
31.
go back to reference Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008;49:256–61.PubMed Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008;49:256–61.PubMed
32.
go back to reference Bender DE, Ewbank D. The focus group as a tool for health research : issues in design and analysis. Heal Transit Rev. 1994;4:63–79. Bender DE, Ewbank D. The focus group as a tool for health research : issues in design and analysis. Heal Transit Rev. 1994;4:63–79.
33.
go back to reference Krueger RA. Focus Groups. Thousand Oaks, CA: Sage; 1988. Krueger RA. Focus Groups. Thousand Oaks, CA: Sage; 1988.
34.
go back to reference Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y. QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. 2012;49:360–71.CrossRefPubMed Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y. QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. 2012;49:360–71.CrossRefPubMed
35.
go back to reference Strauss A, Cobin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. California: Sage; 1990. Strauss A, Cobin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. California: Sage; 1990.
36.
go back to reference Crang P. Analysing qualitative materials. In: Flowerdew R, Martins D, editors. Methods in human geography: a guide to doing a research project. 2nd ed. Essex, England: Pearson Educational ltd; 2005. Crang P. Analysing qualitative materials. In: Flowerdew R, Martins D, editors. Methods in human geography: a guide to doing a research project. 2nd ed. Essex, England: Pearson Educational ltd; 2005.
37.
go back to reference Baxter J, Eyles J. The utility of in-depth interviews for studying the Meaning of Environmental Risk. Prof Geogr. 1999;51:307–20.CrossRef Baxter J, Eyles J. The utility of in-depth interviews for studying the Meaning of Environmental Risk. Prof Geogr. 1999;51:307–20.CrossRef
38.
go back to reference Uwemedimo OT, Arpadi SM, Chhagan MK, Kauchali S, Craib MH, Bah F, et al. Compliance with referrals for non-acute child health conditions: evidence from the longitudinal ASENZE study in KwaZulu Natal, South Africa. BMC Health Serv Res. 2014;14:242.CrossRefPubMedPubMedCentral Uwemedimo OT, Arpadi SM, Chhagan MK, Kauchali S, Craib MH, Bah F, et al. Compliance with referrals for non-acute child health conditions: evidence from the longitudinal ASENZE study in KwaZulu Natal, South Africa. BMC Health Serv Res. 2014;14:242.CrossRefPubMedPubMedCentral
39.
go back to reference Simões PP, Almeida RMVR. Maternal Mortality and Accessibility to Health Services by Means of Transit-Network Estimated Traveled Distances. Matern Child Health J. 2014;18:1506–11.CrossRefPubMed Simões PP, Almeida RMVR. Maternal Mortality and Accessibility to Health Services by Means of Transit-Network Estimated Traveled Distances. Matern Child Health J. 2014;18:1506–11.CrossRefPubMed
40.
go back to reference Hirose A, Borchert M, Cox J, Alkozai AS, Filippi V. Determinants of delays in travelling to an emergency obstetric care facility in Herat, Afghanistan: an analysis of cross-sectional survey data and spatial modelling. BMC Pregnancy Childbirth. 2015;15. Hirose A, Borchert M, Cox J, Alkozai AS, Filippi V. Determinants of delays in travelling to an emergency obstetric care facility in Herat, Afghanistan: an analysis of cross-sectional survey data and spatial modelling. BMC Pregnancy Childbirth. 2015;15.
41.
go back to reference Pierre Ilboudo T, Chou YJ, Huang N. Compliance with referral for curative care in rural Burkina Faso. Health Policy Plan. 2012;27:256–64.CrossRef Pierre Ilboudo T, Chou YJ, Huang N. Compliance with referral for curative care in rural Burkina Faso. Health Policy Plan. 2012;27:256–64.CrossRef
Metadata
Title
Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana
Authors
Kilian Nasung Atuoye
Jenna Dixon
Andrea Rishworth
Sylvester Zackaria Galaa
Sheila A. Boamah
Isaac Luginaah
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1005-y

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue