ABSTRACT

This study investigates women’s access to postnatal healthcare services and their perceptions of service quality in the Buea Health District, South West Region. Despite the critical importance of postnatal care for maternal and infant health, barriers to access and varying perceptions of service quality persist. Through a mixed-methods approach, including surveys and focus group discussions with new mothers, we explore factors influencing access, such as socioeconomic status, education, and cultural beliefs. Our findings reveal significant disparities in service utilization and highlight the need for improved healthcare delivery systems. Additionally, the perception of service quality is shaped by personal experiences and expectations, impacting women’s willingness to seek care. The study underscores the necessity for targeted interventions to enhance access and improve the overall quality of postnatal healthcare services in the region.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Access to quality post-natal healthcare services is a critical determinant of maternal and child health outcomes. In many low- and middle-income countries, including Cameroon, women face significant challenges in accessing these essential services, particularly in rural and underserved areas. The Buea Health District, located in the South West Region of Cameroon, is no exception. Women in this region often encounter barriers such as financial constraints, geographical inaccessibility, cultural norms, and inadequate healthcare infrastructure, which hinder their ability to access timely and effective post-natal care.

Post-natal care plays a pivotal role in ensuring the health and well-being of both mothers and newborns during the first 42 days after childbirth. It includes routine check-ups, vaccinations, treatment of complications, and counselling on infant care and maternal health practices. Despite its importance, studies have shown that poor access to post-natal healthcare services contributes to adverse health outcomes, including maternal morbidity, neonatal mortality, and long-term health complications for both mothers and infants. This period is particularly vulnerable, as complications such as postpartum hemorrhage, infections, and neonatal conditions can arise, often requiring timely medical intervention. Despite its importance, access to post-natal care remains a significant challenge in many low- and middle-income countries (LMICs), including Cameroon.

The Importance of Post-natal Care, Post-natal care encompasses a range of services, including routine check-ups, vaccinations for newborns, treatment of complications, counselling on breastfeeding and infant care, and guidance on family planning. These services are designed to monitor the physical recovery of the mother, address potential health risks, and promote healthy practices for both mother and child. According to WHO guidelines, all women should receive at least three post-natal visits: one within the first 24 hours after delivery, another between 3–7 days, and a third visit at 6 weeks postpartum. However, adherence to these recommendations varies significantly across regions, with LMICs often falling short due to systemic barriers.

In sub-Saharan Africa, where Cameroon is located, maternal and neonatal mortality rates remain alarmingly high. The region accounts for approximately two-thirds of global maternal deaths, with inadequate access to post-natal care being a major contributing factor. For instance, a study by Gabrysch and Campbell (2009) highlighted that only 48% of women in sub-Saharan Africa attend at least one post-natal visit, compared to over 90% in high-income countries. This disparity underscores the urgent need to address gaps in healthcare access and service delivery.

 Cameroon, like many other low- and middle-income countries (LMICs), faces systemic barriers to equitable healthcare access. These challenges are particularly pronounced in rural and underserved areas, such as the Buea Health District. Many households in Cameroon have limited financial resources, making transportation and healthcare costs prohibitive. Compounding this issue, the Buea Health District’s rugged terrain and poor road infrastructure hinder travel, especially for women in remote communities.

Many households in Cameroon operate on limited incomes, making it difficult for women to afford transportation costs or pay for healthcare services, even when they are nominally available.  which complicates travel to healthcare facilities, especially for women living in remote areas. Traditional practices and cultural beliefs often discourage women from seeking formal healthcare services. For example, some communities rely on traditional birth attendants rather than trained healthcare professionals. There is a shortage of healthcare facilities, skilled personnel, and essential medical supplies in the region, further limiting access to quality post-natal care.

These barriers contribute to low utilization rates of post-natal services, which in turn exacerbate adverse health outcomes. Studies have shown that poor access to post-natal care is associated with higher rates of maternal morbidity, neonatal mortality, and long-term health complications for both mothers and infants.

The Buea Health District, located in the South West Region of Cameroon, serves as a microcosm of the broader challenges faced by the country’s healthcare system. The region has a population of approximately 200,000 people, with a significant proportion residing in rural and peri-urban areas. According to the 2020 Cameroon Demographic and Health Survey (DHS), only 53% of women in the South West Region received post-natal care within two days of delivery, compared to the national average of 65%. This discrepancy highlights the unique challenges faced by women in this district.

Furthermore, the ongoing socio-political crisis in the Anglophone regions of Cameroon has exacerbated existing healthcare challenges. Since 2016, the conflict between government forces and separatist groups has disrupted healthcare services, displaced thousands of people, and strained already limited resources.

1.2 Statement of the Problem

Despite global and national efforts to improve maternal and child health outcomes, many women in the Buea Health District do not utilize postnatal care (PNC) services adequately. Studies in similar low-resource settings have identified key barriers to PNC utilization, including poor health infrastructure, shortages of skilled healthcare workers, socio-cultural beliefs, and low levels of education and awareness among women (WHO, 2016; Mbuagbaw et al., 2019). Additionally, even when services are accessed, perceived low quality of care—such as long wait times, inadequate communication, and lack of respectful maternity care—discourages consistent use (Bohren et al., 2017; Afulani et al., 2019). This dissatisfaction can lead to reduced service uptake, poorer health outcomes, and diminished trust in the healthcare system (Sheferaw et al., 2016). 

In the Buea Health District, inconclusive research has been conducted to assess women’s access to postnatal care and their perceptions of service quality. Existing studies in Cameroon highlight systemic challenges, such as geographic and financial barriers, but few focus specifically on postnatal care experiences in the South-West Region (Njim et al., 2018; Anchang-Kimbi et al., 2019). This gap underscores the need for targeted research to generate evidence-based recommendations for policy and program improvements.

Post-natal care is a critical component of maternal and child healthcare, yet its utilization remains alarmingly low in the Buea Health District. According to the 2020 Cameroon Demographic and Health Survey (DHS), only 53% of women in the South West Region received post-natal care within two days of delivery, compared to the national average of 65%. This disparity highlights the unique challenges faced by women in this district, particularly those living in rural and underserved areas.

The consequences of inadequate post-natal care are severe. Globally, complications during the post-natal period account for approximately 15% of maternal deaths and a significant proportion of neonatal deaths (WHO, 2021). In sub-Saharan Africa, where Cameroon is located, these figures are even higher. For instance, postpartum hemorrhage, infections, and hypertensive disorders are among the leading causes of maternal mortality, while neonatal conditions such as sepsis, prematurity, and birth asphyxia contribute to high infant mortality rates. Without timely and effective post-natal care, these conditions often go untreated, resulting in preventable deaths and long-term health complications for both mothers and infants.

This study seeks to address this gap by examining the various factors affecting access to post-natal care and how women perceive the quality of these services. By identifying the root causes of underutilization and dissatisfaction, the study aims to provide evidence-based recommendations that can guide policy formulation and improve service delivery in the Buea Health District.

1.3 Objectives of the Study

1.3.1 Main Objective To examine women’s access to post-natal health care services and their perception of service quality in the Buea Health District.

1.3.2 Specific Objectives

• To identify the factors that influence women’s access to post-natal health care services in Buea Health District.
• To describe women’s perception of the quality of post-natal health care services in the Buea health district.
• To examine the relationship between access to post-natal services and perception of service quality.
• To propose strategies for improving access and quality of post-natal health care services.