JMIR Publications

ABSTRACT

Background:

Maternal and perinatal health are the fundamental of human development, but in Sub-Saharan Africa (SSA) represented low-resource settings which has high birth rate, great challenges in reducing maternal, newborn, and child mortality still exist. To achieve targets of Sustainable Development Goal 3 (SDG3) and Universal Health Coverage (UHC), improving access to continuous maternal and perinatal healthcare services (CMPHS) has been addressed as a critical strategy.

Objective:

This study aims to provide a widely applicable procedure revealing the current challenge in ensuring access to CMPHS for women of reproductive age (WoRA) which supports the propose of targeted suggestion on the priority of resource allocation and policy making in low-resource settings.

Methods:

Following the WHO guidelines and existing literatures, in combing with the local context of CMPHS delivery to WoRA in Mozambique, identification of CMPHS was first proposed as the continuum of three independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then we utilized the nearest-neighbor method (NNM) to assess spatial access to the three service packages, respectively. Finally, we carried out an overlap analysis to identify eight types of resource shortage zones.

Results:

Among the 1542 healthcare facilities in Mozambique in 2018, 784 provided ANC, 365 provided ID, and 299 provided PNC. The average shortest travel time for WoRA to access ANC, ID, and PNC were 2.38h, 3.69h, and 4.16h, respectively. Spatial barrier for WoRA accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo city (0.46h, 0.74h, and 1.34h) showed the shortest travel time and best equity within regions, while the provinces of Niassa (4.07h, 18.20h, and 7.69h) and Inhambane (2.69h, 4.43h, and 10.76h) lagged behind significantly in both aspects. In general, more than 51% of the WoRA (living in 83.25% of Mozambique’s area) were not able to access any service package of CMPHS in time (within two hours), while only about 21% (living in 2.69% of Mozambique’s area) could access CMPHS in a timely manner.

Conclusions:

Spatial accessibility and equity of CMPHS in Mozambique remain challengable for achieveing SDG3 and UHC, especially in Niassa and Inhambane area, and the shortage of ID and PNC was most urgent. For regions with high population density and economic level such as Inhambane, policy-makers should give priority to the implementation of a decentralization allocation strategy which increases coverage and equity through upgrading existing healthcare facilities to be able to provide CMPHS. For regions with the low population density and economic level such as Niassa, the cultivation of well-trained midwives to provide door-to-door ANC and PNC at home by strengthening communities engagment should be given priority. The proposed two-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.