# Unmasking the complexities of healthcare access in low-resource settings: a health systems approach to obstetric and under-5 healthcare in rural settings of Eastern Uganda

## TL;DR

This study explores how multiple factors in rural Uganda limit access to maternal and child healthcare, emphasizing the need for comprehensive health system reforms.

## Contribution

The study reveals how structural and social barriers interact to hinder healthcare access in low-resource settings, calling for holistic health system interventions.

## Key findings

- Family dynamics, such as influence from mothers-in-law and gender roles, limit women's autonomy in seeking healthcare.
- Poor transport infrastructure and road conditions at the community level significantly impede access to health services.
- Negative attitudes and poor service delivery at health facilities discourage future healthcare-seeking behavior.

## Abstract

Access to appropriate obstetric and under-5 healthcare services in low-resource settings is a challenge in countries with high mortality rates. However, the interplay of multiple factors within an ecological system affects the effectiveness of the health system in reaching those in need.

This study examined how multiple factors concurrently affect access to obstetric and child healthcare services in resource-poor settings

The research used social autopsies [in-depth interview] with mothers who experienced newborn death [n = 29], focus group discussions [n = 8] with mothers [n = 32], and fathers [n = 28] of children aged 6–59 months, and the author’s field observations in Eastern Uganda’s rural settings. The research employed narrative and inductive thematic analysis, guided by concepts of social interactions, behaviour, and health institutional systems drawn from system theory.

The study unmasked multiple concurrent barriers to healthcare access at distinct levels. Within families, the influence of mothers-in-law and gender dynamics constrains women’s healthcare-seeking autonomy and agency. At the community level, poor transport system, characterised by long distances and challenging road conditions, consistently impede healthcare access. At the facility level, attitudes, responsiveness, and service delivery of health workers critically affect healthcare access. Negative experiences at health facilities profoundly discourage the community from seeking future health services.

The findings emphasise the persistent influence of structural and social factors that, although well documented, are often overlooked and continue to limit women’s agency and autonomy in healthcare access. Enhancing universal access to appropriate healthcare services requires comprehensive health systems interventions that concurrently address the healthcare access barriers.

Main findings: The findings highlight the persistent influence of structural and social factors that have been well documented yet often overlooked.Added knowledge: While the barriers to and essential components of an effective health system are well known, the current global health space requires an understanding of how the structural, cultural, and social nuances have persistently affected the marginalised communities.Global health impact for policy and action: For a transformative health system, promoting equitable and accessible appropriate healthcare for all necessitates a holistic approach that identifies and addresses healthcare access barriers.

Main findings: The findings highlight the persistent influence of structural and social factors that have been well documented yet often overlooked.

Added knowledge: While the barriers to and essential components of an effective health system are well known, the current global health space requires an understanding of how the structural, cultural, and social nuances have persistently affected the marginalised communities.

Global health impact for policy and action: For a transformative health system, promoting equitable and accessible appropriate healthcare for all necessitates a holistic approach that identifies and addresses healthcare access barriers.