title: Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.
abstract: Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana.
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana.|Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana.
authors.forename: Martin Amogre
authors.identifier: http://orcid.org/0000-0002-4095-3047
authors.initials: MA
authors.lastname: Ayanore
authors.affiliation: Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Regien
authors.initials: R
authors.lastname: Biesma
authors.affiliation: Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana.|Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D000884:Anthropology, Cultural; D036861:Delivery, Obstetric / Q000592:standards; D005260:Female; D005869:Ghana; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D018743:Perinatal Care / Q000592:standards*; D017149:Private Sector; D017150:Public Sector; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards; D055815:Young Adult
keywords: health providers; policy actors; rural northern Ghana; shortcomings for maternity care; women