the role of micro and small scale business enterprises in urban poverty alleviation

159 Pages·2015·1.73 MB·English

ADDIS ABABA UNIVERSITY
SCHOOL OF GRADUATE STUDIES

AN ASSESSMENT OF FACTORS AFFECTING THE
UTILIZATION OF MATERNAL HEALTH CARE SERVICE
DELIVERY: THE PERSPECTIVE OF RURAL WOMEN IN
THE CASE OF DUNA WOREDA, HADIYA ZONE

BY: ABAYCHEW ZELEKE

February 2015
Addis Ababa, Ethiopia
ADDIS ABABA UNIVERSITY
SCHOOL OF GRADUATE STUDIES

AN ASSESSMENT OF FACTORS AFFECTING THE
UTILIZATION OF MATERNAL HEALTH CARE SERVICE
DELIVERY: THE PERSPECTIVE OF RURAL WOMEN IN
THE CASE OF DUNA WOREDA, HADIYA ZONE

A Thesis Submitted to the School of Graduate Studies, Addis Ababa
University, College of Business and Economics, Department of Public
Administration and Development Management in Partial Fulfillment of
the Requirements for the Degree of Master’s of Arts in Public
Administration

BY: ABAYCHEW ZELEKE
ADVISOR: MULUGETA ABEBE (PhD)

February 2015
Addis Abeba, Ethiopia
ADDIS ABABA UNIVERSITY
SCHOOL OF GRADUATE STUDIES

AN ASSESSMENT OF FACTORS AFFECTING THE
UTILIZATION OF MATERNAL HEALTH CARE SERVICE
DELIVERY: THE PERSPECTIVE OF RURAL WOMEN IN
THE CASE OF DUNA WOREDA, HADIYA ZONE

A Thesis Submitted to the School of Graduate Studies, Addis Ababa
University, College of Business and Economics, Department of Public
Administration and Development Management in Partial Fulfillment of
the Requirements for the Degree of Master’s of Arts in Public
Administration

BY: ABAYCHEW ZELEKE

February 2015
Addis Abeba, Ethiopia
A Thesis Entitled:
An Assessment of Factors Affecting the Utilization of Maternal Health Care Service
Delivery: The Perspective of Rural Women In The Case Of Duna Woreda, Hadiya
Zone
By: Abaychew Zeleke
We here certify that this thesis submitted by the name confirms to acceptable standards
and as such fully adequate in scope and quality.
It is therefore, approved as the fulfillment of the thesis requirement for Master of Art
Degree in Public Administration with specialization on Development Management.
Approved by Board of Examiner:

Chair Person, Department Graduate Signature Date
Committee

Advisor Signature Date

Internal Examiner Signature Date

External Examiner Signature Date
Dedication

This thesis work is dedicated to my lovely parents Ato Zeleke Temuro/ Abuye/ and
W/ro Dinknesh Legese/Emuye/ who are the essence of love, source of inspiration,
engine of courage, a cause for my passionate commitment for releasing my potential and
secret for all of my achievements through all aspect of my life.

ii
Acknowledgments
Before all, I praise the almighty God who has never left me alone at those dark days of my
life and giving me endurance to complete my study.
I express my immense appreciation and thanks to my advisor Dr. Mulugeta Abebe for his
unreserved comments, professional advice and considerate consultation from research
proposal preparation to the last point of this thesis.
I am very glad for getting an opportunity to express my unlimited respect, love and thank to
my parents Zeleke Temuro and Dinkinesh Legesse for their love, inspiration, pray and
financial support in every parts of my life. Furthermore, I acknowledge the encouragement
and intellectual support of my fellow colleagues Daniel Amente, Motuma Mosisa, Wodajo
Wami and other unlisted intimate classmates. I will also remember my brotherhood with
Abrham Getachew and Assefa Bayisa for their understanding, integrity, thoughtfulness, and
for all the humorous events we had together.
I, moreover, have unlimited thank and respect to all brothers, sisters and other relatives
especially for Zemenework Beyene and Wondimu Filate who provided me with great
emotional and spiritual support during the two years of my study. I also owe my warmest
gratitude to my brothers who are living in South Africa especially for Tesfaye Dobamo and
Zemedagegn Zeleke for their ever genuine financial and material support.
My special thanks go to Duna Woreda Health Office and staffs for their continuous support
during data collection and field survey. Similarly I would like to thank all enumerators for
their trustworthy and commitment on data collection process. My heartfelt thanks go to all
my household respondents and FGD’s discussants who sacrifice their time and willingness
to be available for interview and discussion to provide me information as fully as possible
which is necessary for my research work.
Finally yet importantly, I am also grateful to Duna Woreda Administration Office for
sponsoring me the fellowship.
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Table of Contents
Contents Page
Acknowledgments ................................................................................................................ i
Table of Contents ................................................................................................................ ii
List of Tables...................................................................................................................... vi
List of Figures .................................................................................................................. viii
List of Acronyms .............................................................................................................. ixx
Abstract ............................................................................................................................... x
CHAPTER ONE: Introduction ............................................................................................ 1
1.1 Background of the Study ............................................................................................ 1
1.2 Statement of the Problem ........................................................................................... 6
1.3 Objective of the Study ................................................................................................ 9
1.3.1 General Objective ................................................................................................ 9
1.3.2 Specific Objectives .............................................................................................. 9
1.4 Basic Research Questions ........................................................................................... 9
1.5 Significance of the Study .......................................................................................... 10
1.6 Scope of the Study ................................................................................................... 11
1.7 Limitations and Challenges of the Study................................................................... 11
1.8 Organization of the Study ......................................................................................... 12
CHAPTER TWO: Review of Related Literature ................................................................ 13
2.1 The Concept of Maternal Health Care Service .......................................................... 13
2.2 Components of Maternal Health Care Service .......................................................... 15
2.2.1 Antenatal Care ................................................................................................... 16
2.2.2 Professionally Assisted and Institutional Delivery .............................................. 19
2.2.3 Postnatal Care .................................................................................................... 21
2.3 Importance of Maternal Health Care Service ............................................................ 23
2.4 International Initiatives on the Improvement of Maternal Health Care Service.......... 25
2.4.1 Global Safe Motherhood Initiative ..................................................................... 25
2.4.2 Millennium Development Goals /MDGs/ as A Framework for Global
Strategies to Improve Maternal Health ............................................................. 28
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2.5 Different Models Related to Maternal Health Care Service Utilization ..................... 33
2.6 Factors Influencing Use of Maternal Healthcare Services ......................................... 38
2.7 Conceptual Framework for Factor Affecting Utilization of Maternal Health Care ..... 43
CHAPTER THREE: Methodology of the Study................................................................. 44
3.1 Description of the Selected Study Area .................................................................... 44
3.2 The Study Population ............................................................................................... 46
3.3 Research Method ...................................................................................................... 47
3.4 Sampling Techniques of the Study ........................................................................... 47
3.5 Inclusion and Exclusion Criteria ............................................................................... 48
3.6 Sample Size of the Study .......................................................................................... 48
3.7 Data Collection Process ............................................................................................ 49
3.7.1 Sources and Types of Data ................................................................................. 49
3.7.2 Data Collection Methods.................................................................................... 50
3.7.3 Pre-Testing of Data Collection Instruments ........................................................ 51
3.7.4 Data Quality Assurance ..................................................................................... 51
3.8 Data Analysis Methods............................................................................................. 52
3.9 Ethical Consideration ............................................................................................... 52
CHAPTER FOUR: Data Presentation, Analysis and Interpretation .................................... 53
4.1 Quantitative Data Presentation and Analysis ............................................................ 53
4.1.1 Profile of Respondents ....................................................................................... 53
4.1.2 Utilization of Antenatal Care ............................................................................. 56
4.1.2.1 Level of ANC Utilization ......................................................................................................... 56
4.1.2.2 Place of ANC Service Receipt .............................................................................................. 57
4.1.2.3 The Type of Professionals Who Provide ANC ............................................................ 57
4.1.2.4 Reasons for not Attending ANC Service ........................................................................ 58
4.1.3 Utilization of Delivery Care Service .................................................................. 58
4.1.3.1 Level of Institutional Delivery Care Utilization ......................................................... 59
4.1.3.2 Level of PADC Service Utilization .................................................................................... 59
4.1.3.3 Place of PADC Service Receipt ........................................................................................... 60
4.1.3.4 The Type of Professionals who Assisted During PADC Service ..................... 60
4.1.3.5 Reason for not Utilizing PADC Service .......................................................................... 61
iii
4.1.4 Utilization of Postnatal Care Service/PNC/ ........................................................ 62
4.1.4.1 Level of Utilization of PNC .................................................................................................... 62
4.1.4.2 Place of PNC Service Receipted .......................................................................................... 63
4.1.4.3 The Type of Professionals who Provide PNC Service ............................................ 63
4.1.4.4 Reason for Non-Attendance of PNC ................................................................................. 64
4.1.5 Result of Bivariate Analysis ............................................................................... 65
4.1.5.1 Factors Affecting ANC Service Utilization in Duna Woreda ............................. 65
4.1.5.1.1 Relationship between Selected Socio-Economic Factors and ANC
Service Utilization ................................................................................ 65
4.1.5.1.2 Relationship between Selected Areal Factors and ANC Service
Utilization ............................................................................................. 70
4.1.5.1.3 Relationship between Selected Institutional Factors and ANC Service
Utilization ...................................................................................................................................... 72
4.1.5.1.4 Relationship between Selected Socio-Cultural and Psychological
Factors and ANC Service Utilization .................................................... 76
4.1.5.2 Relationship between Selected Socio-Economic Factors and
Utilization of PADC Service ................................................................. 79
4.1.5.2.1 Relationship between Selected Areal Factors and PADC Service
Utilization ............................................................................................. 83
4.1.5.2.2 Relationship between Selected Institutional Factors and PADC
Service Utilization ................................................................................ 85
4.1.5.2.3 Relationship between Selected Socio-Cultural and Psychological
Factors and Utilization of PADC Service .............................................. 90
4.1.5.3 Factor Affecting PNC Service Utilization in Duna Woreda ................................ 93
4.1.5.3.1 Relationship between Selected Socio-Economic Factors and
Utilization of PNC Service.................................................................... 93
4.1.5.3.2 Relationship between Selected Areal Factors and Utilization of PNC
Service.................................................................................................. 97
4.1.5.3.3 Relationship between Selected Institutional and Utilization of PNC
Service.................................................................................................. 99
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4.1.5.3.4 Relationship between Selected Socio-Cultural and Psychological and
Utilization of PNC Service.................................................................. 103
4.2 Qualitative Data Presentation and Analysis ............................................................ 106
4.2.1 The Status of Antenatal Care Utilization .......................................................... 106
4.2.2 The Status of Professionally Assisted Delivery Care Utilization ....................... 107
4.2.3 The Status of Postnatal Care Utilization ........................................................... 108
4.2.4 Socio-Economic Factors .................................................................................. 109
4.2.5 Area Related Factors ........................................................................................ 110
4.2.6 Institutional Service Delivery Related Factors .................................................. 111
4.2.7 Socio-Cultural and Psychological Factors ........................................................ 114
CHAPTER FIVE: Summary of Major Findings, Conclusion and Recommendation ......... 116
5.1 Summary of Major Findings ................................................................................... 116
5.2 Conclusion ............................................................................................................. 119
5.3 Recommendation ................................................................................................... 121
Reference
Appendices
v