Benefits and challenges of voucher-based transport for skilled birth attendance in Kitui County, Kenya: the health stakeholders’ perspectives

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BACKGROUND: Reducing maternal, newborn and child mortality remains one of the top global public health priorities. Each year, approximately 303,000 mothers, globally, die during delivery. Stillbirths and neonatal deaths within the first 28 days of life are estimated at 2.6 million and 2.7 million, respectively. Rural residents face challenges in accessing health care due to difficulties in transportation. Given the voucher-based transport's potential to address inaccessibility to health services, this study explored the health stakeholders' perspectives on the benefits and challenges of this intervention. METHODS: Using an exploratory qualitative design, this study was conducted in Kitui County located in the lower Eastern part of Kenya. The study was conducted from July to August 2023, with data collection occurring over a two-week period in August 2023. Participants were purposively drawn from the six wards in Kitui South Sub County. The interview guide included questions on views, experiences, challenges, and perspectives on voucher-based transport system for skilled birth attendance. Data triangulation was ensured through audio-recorded Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). All audio recordings were transcribed verbatim, coded and thematically analyzed, using a holistic approach. RESULTS: Perceived benefits of Skilled Birth Attendance (SBA) champions model included improved access to delivery services, improved health outcomes and socioeconomic and awareness benefits. The perceived challenges and concerns of the SBA model included economic and sustainability challenges, infrastructure and connectivity challenges, as well as administrative and logistical challenges. CONCLUSIONS: Overall, the SBA Champions model has proven effective in improving access to maternal services within the community, but prevailing challenges and sustainability issues need to be addressed. Additionally, the study provided strategic information to inform policy makers about the model and strengthen MCH policy.

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