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


CONCLUSIONS
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.
Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 5C2, Canada. katuoye@uwo.ca.
Kilian Nasung
KN
Atuoye
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. jenna.dixon@uwaterloo.ca.
Jenna
J
Dixon
Department of Geography, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. arishworth@uwaterloo.ca.
Andrea
A
Rishworth
Department of Integrated Development Studies, University for Development Studies, Wa Campus, Upper West Region, Ghana. sylvestergalaa@yahoo.com.
Sylvester Zackaria
SZ
Galaa
Arthur Labatt Family School of Nursing, Health Services Addition, University of Western Ontario, London, ON, N6A 5C1, Canada. sboamah@uwo.ca.
Sheila A
SA
Boamah
Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 5C2, Canada. iluginaa@uwo.ca.
Isaac
I
Luginaah
D000328:Adult; D002648:Child; D000067576:Child Health; D002662:Child Health Services; D003695:Delivery of Health Care; D004632:Emergency Medical Services; D005190:Family; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008427:Maternal Health Services; D008875:Middle Aged; D008880:Midwifery; D011203:Poverty; D011247:Pregnancy; D012424:Rural Population; D014186:Transportation; D014481:United States