Women’s voice to improve the quality of maternal health care provision in Burundi: challenges and perspectives

P. Niyongabo, G. Ntahimpereye, J. Mategeko, G. Nsengiyumva, M. Dieleman, T. De Cock Buning

Background

More than a decade of civil war in Burundi left the health system including maternal health services delivery destructed. Free care for women aimed to improve access to service delivery was decided upon. This did not achieve sustainable results unveiling the need for more innovative solutions. One option is the use of social accountability to improve maternal health services; an approach in which citizen express their needs stimulating service providers to be responsive. An exploratory study was carried out  in two provinces of Burundi in 2013   to identify and discuss community  perceptions on the quality of maternal health provision in order to discuss opportunities to use or strengthen social accountability mechanisms for maternal health provision in Burundi.

Methodology

Semi-structured interviews were used to collect data from community informants made of men, women, community health workers, health community members, community leaders, religious leaders, health and administrative authorities and health providers. Data  analysis  facilitated by MAXDA 11 software proceeded with data coding and the constant comparison was used for  content analysis.

Results

Citizens especially women hold grievances against maternal health care provision: the staff bad attitude  and disrespect towards women; Staff’s lack of skills, delay to be received in the health facility  were mostly pointed out. The majority of women are reluctant to express directly their claims and dissatisfaction about maternal health provision to the medical staff. In case women decide to speak out, they  use   intermediaries  mostly community health workers . Gossip is also used with the hope that it can spread out and reach health providers.  Most of providers do not understand the needs for a warm welcome ; dialogue with women ; a good attitude towards them and are not hence responsive to their needs.

Conclusion

Social accountability for maternal health services does  not yet exist in Burundi .For its implementation, women voice needs to be strengthened  by the mean of a dialogue facilitated by an independent  structure that will allow free expression for women and medical staff and organize a  constant dialogue between women and health providers.