Health systems factors that impact on access to maternal services for women with disabilities in sub-Saharan Africa: a systematic review

Master Thesis


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University of Cape Town

Maternal mortality is an enormous global challenge that is most prevalent in sub-Saharan Africa (SSA). Its prevalence in the SSA region has been attributed to inadequate access to maternal services (MHS) amongst the poor and rural women. In an attempt to improve access to maternal services, women with disabilities (WWDs) have generally been neglected. Little is known about the health systems factors that facilitate or hinder access to MHS for WWDs. However, available studies for women in general in SSA, examining health systems determinants of access to MHS, utilise the silo approach thereby providing fragmented and ineffective solutions to maternal mortality. Globally, taking a comprehensive health systems approach to understand the full range and interconnectedness of health factors is now recognised as crucial in understanding and planning complex health problems such as access to MHS. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on the health systems factors that impact on access to MHS for WWDs in SSA. This dissertation comprises three sections, namely Part A, Part B and Part C. Part A reviews the Protocol; it presents the background and the qualitative systematic review methodology that is utilised in this study. A systematic search of five data bases is outlined and inclusion and exclusion criteria set out to select the suitable tool. A data extraction tool is designed to summarise the studies in a common format and to facilitate synthesis and coherent presentation of data. Part B is the review of existing empirical literature on access to MHS for both women in general SSA and for WWDs globally. Theoretical frameworks of access to health care services and health systems frameworks are also presented in this section. Furthermore, Part B provides the background on why access to MHS for WWDs is important. This section explores how health systems approach can be adopted to reveal the factors that impact on access to MHS; it links the complex systems framework to the availability, accessibility, acceptability and quality framework. Part C is a complete systematic review journal manuscript. The background of the study and methodology are described. This section also includes the findings from the systematic review of original journal articles published in English from 2000 to 2014 that report empirical findings on health systems factors that impact on access to MHS WWDs in SSA.

Includes bibliographical references