title: Infrastructural challenges to better health in maternity facilities in rural Kenya: community and healthworker perceptions.
abstract: BACKGROUND
  The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas.
  
  
  METHODS
  This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities.
  
  
  RESULTS
  The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations.
  
  
  CONCLUSIONS
  The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Hildah
authors.initials: H
authors.lastname: Essendi
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Fiifi Amoako
authors.initials: FA
authors.lastname: Johnson
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Nyovani
authors.initials: N
authors.lastname: Madise
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Matthews
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Jane
authors.initials: J
authors.lastname: Falkingham
authors.affiliation: Engineering and the Environment, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Abubakr S
authors.initials: AS
authors.lastname: Bahaj
authors.affiliation: Engineering and the Environment, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: James
authors.affiliation: Engineering and the Environment, University of Southampton, SO17 1BJ, Southampton, UK. hildah.essendi@gmail.com.
authors.forename: Luke
authors.initials: L
authors.lastname: Blunden
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006268:Health Facilities / Q000191:economics / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D011247:Pregnancy; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D012424:Rural Population