User and provider perspectives on emergency obstetric care in a Tanzanian rural setting: A qualitative analysis of the three delays model in a field study
), Birgitte BruunNielsen(2), Vibeke Rasch(3), Peter Elsass(4),
(1)
(2)
(3)
(4)
Corresponding Author
Abstract
The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems they were facing in the context of poverty. Local health professionals were aware of the poor quality of care at health facilities but were still blaming the community. The study describes the difficulties within the conceptual framework of the widely used “three delays model”to disentangle different perspectives and to identify a feasible strategy of action to improve access to timely and effective emergency obstetric care. There seems to be a need for a supplementary analytic model that more clearly has the health system as the central agent responsible for improving maternal health. A modified “actantial model is suggested for that purpose.
RésuméCette enquête sur le terrain avait pour objectif d'analyser les dynamique et les conflits centraux par rapport à l'assurance du soin d'accouchement dans un cadre rurale tanzanien. Les femmes et les parents n'ont pas perçu les problèmes de la grossesse et de l'accouchement isolément, mais en relation aux autres multiples problèmes auxquels elles font face dans le contexte de la pauvreté. Les professionnels de santé locaux étaient au courant de la mauvaise qualité de soin dans les établissements sanitaires, mais elles blâmaient toujours la communauté. L'étude fait une description des difficultés dans le cadre conceptuel du « modèle des trois retards » qui est communément utilisé pour démêler les perspectives différents et pour identifier une stratégie d'action faisable pour améliorer l'accès à un soin obstétrique d'urgence opportun et efficace. Il semble qu'il y ait le besoin d'un modèle analytique supplémentaire a plus clairement le système de santé comme l'agent central qui est responsable de l'amélioration de la santé maternelle. Un « modèle actionnel » est préconisé pour la circonstance.
Key words: Teenage pregnancy, Cross-sectional Survey, Secondary School, Nigeria, High School Drop-out
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