Health systems factors affecting maternal health service delivery. By Angela Kisakye

In Uganda maternal health is still on top of the agenda for the government despite the improvements registered in maternal mortality ratio (MMR) over the years. The most common systems issues underlying maternal health care have been found to be the human resource structures and financing mechanisms. The functionality of the different health system building blocks is critical in ensuring that health care systems are able to deliver care in the most effective way possible. It should be recognized that all the health system building blocks are interdependent and therefore require an integrated approach to improvement. For example while skilled attendance at birth is essential, maternal outcomes are still affected by the systems in which they occur. For example, in 2005 Uganda had over three times the skilled attendance rate (39%) than Bangladesh (12%) but estimates of MMR were higher in Uganda at 505 compared with 322 for Bangladesh. Explanations for this disparity were systemic such as the quality of hospital care; availability of medicine and doctors to handle complications and geographical barriers to accessing health service. This blog provides an outline of the different health system building blocks and how they affect maternal health outcomes

Information systems: An established health information system (HIS) has been shown to be vital in getting health systems ahead. Countries that have multiple stand alone information systems that are managed by different entities/ divisions for instance in Namibia have reported low utilization of locally generated data to improve health outcomes.

Financing: A good health financing system raises adequate funds in ways that allow people to use needed services while being protected from financial catastrophe and impoverishment associated with having to pay. For low-income countries to meet the US$ 34 recommended by WHO's Commission on Macroeconomics and Health, there is need for an optimized combination of in-country equitable health financing and funding from donors

Leadership and governance: Proper leadership and management practices are critical in enabling managers at different levels of the healthcare system identify obstacles to skilled facility-based deliveries and improved maternal and newborn health outcomes.

Human resources: Availability of national human resources for health (HRH) strategic plans that focus on training, recruitment, retention and management is critical in ensuring that health services are delivered in the most effective way possible.

Medical products and technologies: Medicine stock outs in LMICs has been reported as a major contributor to the negative maternal health outcomes especially among the poor and marginalized communities.

Service delivery: It is evident that there is a big gap in the implementation of health care programmes and service packages within the continuum of care in many LMICs. This is especially due to the lack of appropriate resources to support effective programmes, inappropriate dissemination of policies and guidelines at the lower health facility levels and the limited capacity of health facilities nearest to families and communities.

It cannot be underestimated how much health system issues influence the access to and utilization of services, quality of care provided, and ultimately maternal health outcomes.