Khatri Resham Bahadur, Dangi Tara Prasad, Gautam Rupesh, Shrestha Khadka Narayan, Homer Caroline S E
Center for Research and Development, Kathmandu, Nepal.
Ministry of Home Affairs, Government of Nepal, Kathmandu, Nepal.
PLoS One. 2017 May 11;12(5):e0177602. doi: 10.1371/journal.pone.0177602. eCollection 2017.
Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers.
We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis.
Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center.
The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.
孕产妇死亡率和发病率是尼泊尔的公共卫生问题。在农村社区，尽管有农村分娩中心，但许多妇女在没有熟练助产士支持的情况下在家分娩。本研究的目的是探讨障碍，并为改善农村分娩中心的服务提供和利用提出切实可行的建议。
我们在鲁库姆区的一个农村社区对服务使用者和提供者进行了26次深入访谈，并与社区关键信息提供者进行了3次焦点小组讨论。我们使用阿迪蒂亚·卡塔曼奇逻辑模型作为数据分析的指导框架。
服务不规律、质量差、人力和资金资源不足以及治理不善是阻碍服务提供的卫生系统挑战。还发现包括地理条件恶劣、分娩准备不足、有害文化习俗和传统以及信任度低等背景障碍也导致了分娩中心利用率低下。
农村分娩中心在妇女需要时没有提供高质量服务，这意味着由于系统和背景障碍，妇女没有正确使用现有的服务。提高认识活动、当地资源调动、确保获得熟练的提供者和设备以及其他长期基础设施建设等方法可以提高农村分娩中心分娩服务的质量和利用率。这对尼泊尔和其他类似国家的其他中心具有借鉴意义。
