Browsing by Author "Parkhurst, Justin O."

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    Assessing access barriers to maternal health care: measuring bypassing to identify health centre needs in rural Uganda
    (Health policy and planning, 2009) Parkhurst, Justin O.; Ssengooba, Freddie
    In low income countries, several barriers exist to the use of health services for child delivery, including distance, transportation, informal costs or low perceived quality. Yet there is rarely information about which barriers are more or less important to the use of a given health facility. This study assessed the relative importance of different barriers to maternal health facility use in rural Uganda through the use of simple indicators based on locally available data. Methods Data from public health facilities performing deliveries in a rural district were used along with census information to construct a set of indicators useful for diagnosing barriers to delivery service use. Indicators included the number of facility-based deliveries per 1000 women served, the proportion of users from a facility’s local area, and a new indicator, the ‘bypassing ratio’, defined as the number of women from a facility’s local area who delivered in other facilities, divided by the number of local women using the facility itself. Results Numbers of deliveries varied greatly between facilities of the same level. A few very low use facilities saw over 75% of women come from the local area, while other facilities services attracted a large majority of women from other areas. The phenomenon of bypassing provides additional insight into the relative importance of distance or transport as opposed to internal facility factors preventing use.
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    Health systems factors influencing maternal health services: a four-country comparison
    (Health policy, 2005) Parkhurst, Justin O.; Penn-Kekana, Loveday; Blaauw, Duane; Balabanova, Dina; Danishevski, Kirill; Rahman, Syed A.; Onama, Virgil; Ssengooba, Freddie
    It is widely understood that maternal health care relies on the entire health system. However, little empirical, country-specific, research has been done to trace out the ways in which health system elements can shape maternal health outcomes. This study seeks to redress this situation, by providing an example of how a health systems approach can benefit the understanding of maternal health services. A comparative analysis was conducted based on extensive case studies of maternal health and health systems in Bangladesh, Russia, South Africa, and Uganda. A number of cross-cutting health system characteristics affecting maternal health were identified by comparing these diverse settings. The most important common systems issues underlying maternal health care were found to be the human resource structures, the public–private mix of service provision, and the changes involved with health sector reforms. Specific country contexts can further determine many factors influencing maternal health outcomes and service performance. Systems issues were found to influence the access to and utilization of services, quality of care provided, and ultimately maternal health outcomes. This paper provides a first step in tracing out how such broad systems issues actually work to influence maternal health