Evidence map›Paper›PMID 40849618›Full record

SynthesisBMC pregnancy and childbirth2025

Health system responsiveness for maternal healthcare services in East Africa: a mixed-methods systematic review.

Ayal Debie, Molla M Wassie, Claire T Roberts, Meseret Derbew Molla, Annabelle Wilson, Jacqueline H Stephens

Erratum issuedAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Ayal DebieCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia. tefe0004@flinders.edu.au.ORCID http://orcid.org/0000-0002-5596-8401
Molla M WassieCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.ORCID http://orcid.org/0000-0002-3565-2397
Claire T RobertsCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.ORCID http://orcid.org/0000-0002-9250-2192
Meseret Derbew MollaCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.ORCID http://orcid.org/0000-0002-2622-522X
Annabelle WilsonCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.ORCID http://orcid.org/0000-0003-4308-8113
Jacqueline H StephensCollege of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.ORCID http://orcid.org/0000-0002-7278-1374

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHealth system responsiveness (HSR) is the ability to respond to universal legitimate expectations of service consumers. This contributes to achieving short and long-term health sector goals, such as universal health coverage. However, no comprehensive summary of evidence exists on how HSR can achieve universal maternal health services. Therefore, we aim to examine the successes, challenges, and strategies of HSR toward universal maternity care in East Africa using a mixed-methods systematic review.

methodsWe conducted a mixed-methods systematic review of studies published from 1 January 2020 to 8 June 2024. Articles were searched using six databases: Medline, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest. We used three main search terms: HSR, maternal health, and East Africa. A mixed-methods appraisal tool (MMAT) was used to assess the quality and methodological validity of the studies. We then analysed and synthesised the data using the World Health Organization (WHO) HSR framework components.

resultsA total of 72 articles (23 quantitative, 15 mixed-method, and 34 qualitative articles) were included. This review revealed that the responsiveness of obstetric services ranged from 45.8 to 75.6%. Challenges contributing to poor HSR, include limited decision-making autonomy, breaches of confidentiality, non-dignified care, poor communication, delay in care, and unhygienic maternity care. However, maintaining confidentiality, providing abuse-free care, permitting companions, and ensuring informed consent improved responsiveness of maternity care.

conclusionThe included studies reported wide ranges of the overall HSR and its specific domains for maternity care. Unresponsive health system remains a significant challenge for achieving universal access to maternal healthcare services. As such, HSR continues to hinder quality of maternal healthcare and its utilisation. Ensuring responsive maternity services requires continuous attention from policymakers, managers, and healthcare providers. Strengthening HSR will promote inclusive, effective, and respectful care that safeguards women's rights and ensures equitable care regardless of their circumstances.

Indexed as

Health Services AccessibilityMaternal Health ServicesAfrica, EasternFemaleHumansPregnancyQuality of Health CareEast africaHealth system responsivenessMaternal health serviceUniversal

Identifiers

PMID40849618
PMCPMC12374364

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.