Bottleneck Analysis of Maternal, Newborn and Child Health Services in Underserved Areas of Kwale County, Kenya.

Background: Kenya experienced a 55% increase in maternal mortality between the years 2017 and 2020. While the global targets are yet to be realized, neonatal and infant mortality has improved over the years, but the rate of decline for neonatal mortality has been slow. The persistent high maternal mortality and slow improvements in neonatal and infant mortality warrant regular inquiries into health service provision, its quality and uptake. Objective: We assessed bottlenecks in accessing reproductive, maternal, newborn and child health (RMNCH) services in Kwale County, Kenya. Design: We used a cross sectional mixed methods approach. Methods: We adapted the Tanahashi model to evaluate RMNCH services using 5 key measures that reflect different stages along the service delivery continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Secondary quantitative data was collected from the Kenya Demographic and Health Survey 2022, Kenya Health Facility Census Report 2023 and other peer reviewed publications. Primary qualitative data was collected from 20 focus group discussions with 176 members including lay community members, community health promoters (CHPs) and traditional birth attendants. Primary data was collected over a 1 month period, between October and November 2022. Results: The main bottleneck identified from the supply side was the limited number and negative attitude of the healthcare workers. Access to core health workers was at 13/10 000 people, lower than the national average and World Health Organization (WHO) recommendation. From the supply side, low health literacy, gender norms and financial constraints were the major factors fueling the poor health seeking behavior. Conclusion: Kwale County needs to prioritize investments in human resources for health, advocacy, communication and social mobilization.