Ganle John Kuumuori, Fitzpatrick Raymond, Otupiri Easmon, Parker Michael
Population, Health and Gender Studies Group, Department of Geography and Rural Development, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Int J Health Plann Manage. 2016 Oct;31(4):e235-e253. doi: 10.1002/hpm.2291. Epub 2015 Mar 30.
Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.
在包括加纳在内的撒哈拉以南非洲国家，获得和利用熟练接生服务的机会不足已被确定为孕产妇和新生儿健康状况不佳的一个主要促成因素。然而，以往许多研究分娩规范和就医行为的研究都集中在确定不使用服务的规范上，而不是那些能够促进服务利用的因素。基于对加纳六个社区共185名孕妇和哺乳期妇女以及20名医疗服务提供者进行的初步定性研究，本文报告了可用于克服使用熟练接生服务的卫生系统障碍的策略。确定的策略包括扩大和重新分配现有的孕产妇保健资源和基础设施、培训更多熟练的产科护理人员、制定针对最需要帮助的妇女的特别方案、提高所提供的孕产妇保健服务的质量、改善产科病房的医患关系、促进选择、在产科病房保护隐私和患者尊严以及与传统助产士和其他非国家行为者建立伙伴关系。研究结果表明，需要对产科诊所和常规护理做法进行结构调整，包括强调那些对妇女就医行为有积极影响的医患关系做法。版权所有© 2015约翰·威利父子有限公司。
