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The role of the health system in women's utilisation of maternal health services in Sudan

Ibrahim, Ghada (2015). The role of the health system in women's utilisation of maternal health services in Sudan. (Unpublished Doctoral thesis, City, University of London)


Background: Maternal mortality and morbidity still pose a significant challenge in Sudan, where no significant improvements in maternal health have been achieved despite the focus on the Millennium Development Goals. Under-utilisation is a major public health concern even though Sudan is among the African countries that have registered poor maternal and child health. Health services in Sudan are generally limited and with poor quality and disparate access. Therefore, there is a need for better understanding of the barriers to the provision and utilisation of maternal health services in order to improve the health and survival of Sudanese mothers.

Objectives: This study sought to assess the maternal health system functions and influences on utilisation as well as the social, cultural, and women’s characteristics that may constitute barriers to utilisation.

Methodology: The study used an explanatory sequential mixed-methods design. A comprehensive analysis was conducted using several quantitative and qualitative data sets, guided by a new framework, the Maternal Health System Performance framework (MHSP) developed as part of this work in order to assess both the three objectives and four functions of the health system on both macro and micro levels.

Findings: The study findings provide clear evidence that the Sudan health system is not currently capable of achieving an adequate level of attainment of the health goals or equitable distribution, due to dysfunction of the four health system functions. In addition, the findings draw attention to the important role of the stewardship function in health system performance. This function can play a key role in health system reform, as it influences management of the health system and should work across all elements of the system to ensure a well-functioning health system and efficient use of resources. The findings also underline the important role of health system related factors rather than simply population factors (such as individual, household, and community factors) in the low service utilisation among women in poor settings. While it shows that certain population characteristics such as household income and education do have a significant impact on the utilisation, the health system functions, and in particular the stewardship function, are also demonstrated to be of considerable importance.

Implication: These findings have implications for policy and practice, indicating that simply blaming women for not using maternal health services is unhelpful and inappropriate and indicate that decision makers should focus more fully on improving the performance of the health system. According to the comprehensive assessment of the health system performance, the study proposes several recommendations for each health system function to enhance the performance in the context of limited resources, ultimately to improve women’s and community health in Sudan.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences
Text - Accepted Version
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