| dc.description.abstract | Maternal and Newborn Health (MNH) is of paramount importance in the realm of attaining
sustainable development goals that also focuses on universal health coverage (UHC). The
study aimed at identifying and exploring the bottlenecks in MNH services in Hard-to-reach
(HtR) areas of Bangladesh using the Tanahashi framework exploring the possible remedial
approaches. The study was conducted in four different types of HtR areas (hilly, coastal,
lowlands, and river islands) by utilizing a sequential explanatory mixed-method design.
Overall, we collected information from 20 health facilities and 2,989 households by inter-
viewing 2,768 recently delivered women (RDW) with a structured questionnaire and qualita-
tive interviews (n = 55) of facility managers, local stakeholders, RDWs, and health care
providers (HCP). The quantitative data were analyzed principally for descriptive statistics
and the qualitative data was analyzed by utilizing the thematic approach. Antenatal care,
under-5 care, and family planning services were available in almost all the facilities. How-
ever, Normal vaginal deliveries were performed in 55.6% of the union-level facilities. Only
40% of sub-district level facilities had provision for C-sections. Blood transfusion services
were available in only 20.1% of facilities, whereas laboratory services were obtainable in
51.7% of facilities. Overall, the bottlenecks were identified in cases of availability of drugs,
human resources, transportation, lack of knowledge regarding different essential services
and health components, out of pocket expenditure etc. There have been several remedial
approaches suggested from both the demand and supply side that included incentives for
care providers for staying in these areas, a coordinated transport/referral system, and health
education campaigns. More research works are warranted in HtR areas, especially to test
the proposed interventions. Meanwhile, the government should take the necessary steps to
overcome the bottlenecks identified. | en_US |
