{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T14:39:10Z","timestamp":1771511950471,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T00:00:00Z","timestamp":1627862400000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000193","name":"International Development Research Centre","doi-asserted-by":"crossref","award":["108041"],"award-info":[{"award-number":["108041"]}],"id":[{"id":"10.13039\/501100000193","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this paper is to explore policy-makers and clinical managers\u2019 views on maternal health service delivery in rural Nigeria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This is a qualitative study using key informant interviews. Participants\u2019 responses were audio recorded and reflective field notes supplemented the transcripts. Data were further analysed with a deductive approach whereby themes were organised based on existing literature and theories on service delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The study was set in Esan South East (ESE) and Etsako East (ETE), two mainly rural local government areas of Edo state, Nigeria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>The study participants consisted of 13 key informants who are policy-makers and clinical managers in ESE and ETE in Edo state. Key informants were chosen using a purposeful criterion sampling technique whereby participants were identified because they meet or exceed a specific criterion related to the subject matter.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Respondents generally depicted maternal care services in primary healthcare centres as inaccessible due to undue barriers of cost and geographic location but deemed it acceptable to women. Respondents\u2019 notion of quality of service delivery encompassed factors such as patient-provider relationships, hygienic conditions of primary healthcare centres, availability of skilled healthcare staff and infrastructural constraints.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study revealed that while some key aspects of service delivery are inadequate in rural primary healthcare centres, there are promising policy reforms underway to address some of the issues. It is important that health officials advocate for strong policies and implementation strategies.<\/jats:p><\/jats:sec>","DOI":"10.1136\/fmch-2021-000994","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T16:32:22Z","timestamp":1628008342000},"page":"e000994","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["\u201cWe have either obsolete knowledge, obsolete equipment or obsolete skills\u201d: policy-makers and clinical managers\u2019 views on maternal health delivery in rural Nigeria"],"prefix":"10.1136","volume":"9","author":[{"given":"Ogochukwu","family":"Udenigwe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friday E","family":"Okonofua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorretta F C","family":"Ntoimo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson","family":"Imongan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Igboin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4876-6043","authenticated-orcid":false,"given":"Sanni","family":"Yaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"2021080308551763000_9.3.e000994.1","unstructured":"WHO . Maternal Mortality: Key Facts. In: WHO Health Topics [Internet], 2019. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality [Accessed 2 Feb 2020]."},{"key":"2021080308551763000_9.3.e000994.2","unstructured":"World Health Organization (WHO) . WHO | Maternal health in Nigeria: generating information for action. In: Sexual and reproductive health [Internet]. World Health Organization, 2019. Available: http:\/\/www.who.int\/reproductivehealth\/maternal-health-nigeria\/en\/ [Accessed 1 Jun 2021]."},{"key":"2021080308551763000_9.3.e000994.3","unstructured":"WHO. UNICEF. UNFPA . Trends in maternal mortality: 1990 to 2015 estimates by who, UNICEF, UNFPA, world bank group and the United nations population division. Geneva, 2015."},{"key":"2021080308551763000_9.3.e000994.4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3389\/fpubh.2017.00048","article-title":"Primary Health Care in Nigeria: 24 Years after Olikoye Ransome-Kuti\u2019s Leadership","volume":"5","author":"Aregbeshola","year":"2017","journal-title":"Front Public Health"},{"key":"2021080308551763000_9.3.e000994.5","first-page":"693","article-title":"Basic health services in Nigeria: models for primary care in America","volume":"71","author":"Dungy","year":"1979","journal-title":"J Natl Med Assoc"},{"key":"2021080308551763000_9.3.e000994.6","unstructured":"World Bank . Improving primary health care delivery in Nigeria evidence from four states 2010."},{"key":"2021080308551763000_9.3.e000994.7","unstructured":"Omuta GED , Onokerhoraye AG , Okonofua F . Perspective on primary healthcare in Nigeria, past, present and future. CPED monograph series 2014."},{"key":"2021080308551763000_9.3.e000994.8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0140-6736(79)90622-6","article-title":"Declaration of Alma-Ata","volume":"313","author":"Beard","year":"1979","journal-title":"Lancet"},{"key":"2021080308551763000_9.3.e000994.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-019-2433-1","article-title":"Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria","volume":"19","author":"Ntoimo","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"2021080308551763000_9.3.e000994.10","doi-asserted-by":"crossref","first-page":"594","DOI":"10.4103\/1119-3077.141425","article-title":"Clients' knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria","volume":"17","author":"Nnebue","year":"2014","journal-title":"Niger J Clin Pract"},{"key":"2021080308551763000_9.3.e000994.11","article-title":"Improving quality of care in primary health-care facilities in rural Nigeria: successes and challenges","volume":"3","author":"Ugo","year":"2016","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"2021080308551763000_9.3.e000994.12","first-page":"1","volume-title":"Monitoring the building blocks of health systems: a Handbook of indicators and their measurement strategies","volume":"35","year":"2010"},{"key":"2021080308551763000_9.3.e000994.13","first-page":"45","article-title":"Orthodox versus unorthodox care: a qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria","volume":"26","author":"Okafor","year":"2014","journal-title":"Malawi Med J"},{"key":"2021080308551763000_9.3.e000994.14","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-13-53","article-title":"Consumer knowledge and availability of maternal and child health services: a challenge for achieving mdg 4 and 5 in Southeast Nigeria","volume":"13","author":"Emmanuel","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2021080308551763000_9.3.e000994.15","unstructured":"World Health Organization . Multi-Stakeholder Dialogues for Women \u2019 s and Children \u2019 s Health\u202f: A Guide for Conveners and Facilitators, 2014."},{"key":"2021080308551763000_9.3.e000994.16","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2021080308551763000_9.3.e000994.17","unstructured":"Gilchrist VJ , Williams RL , Second KII Crabtree BF , Miller WL , eds. Doing qualitative research. 2nd edn. SAGE Publications, Inc, 1999: 71\u201388."},{"key":"2021080308551763000_9.3.e000994.18","doi-asserted-by":"crossref","DOI":"10.1186\/s41256-018-0066-y","article-title":"Increasing women's access to skilled pregnancy care to reduce maternal and perinatal mortality in rural Edo state, Nigeria: a randomized controlled trial","volume":"3","author":"Yaya","year":"2018","journal-title":"Glob Health Res Policy"},{"key":"2021080308551763000_9.3.e000994.19","unstructured":"Patton MQ . Designing qualitative studies. In: Qualitative evaluation and research methods, 1990."},{"key":"2021080308551763000_9.3.e000994.20","first-page":"1408","article-title":"Are We There Yet\u202f? Data Saturation in Qualitative Research Are We There Yet\u202f?","volume":"20","author":"Fusch","year":"2015","journal-title":"Data Saturation in Qualitative Research"},{"key":"2021080308551763000_9.3.e000994.21","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-017-0574-8"},{"key":"2021080308551763000_9.3.e000994.22","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/EFI-2004-22201","article-title":"Strategies for ensuring trustworthiness in qualitative research projects","volume":"22","author":"Shenton","year":"2004","journal-title":"EFI"},{"key":"2021080308551763000_9.3.e000994.23","first-page":"1","article-title":"The quest for rigor in qualitative studies: strategies for institutional researchers","volume":"52","author":"Billups","year":"2014","journal-title":"NERA Res"},{"key":"2021080308551763000_9.3.e000994.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015271"},{"key":"2021080308551763000_9.3.e000994.25","first-page":"7","article-title":"Primary health care, selective or comprehensive, which way to go?","volume":"80","author":"Obimbo","year":"2003","journal-title":"East Afr Med J"},{"key":"2021080308551763000_9.3.e000994.26","doi-asserted-by":"crossref","first-page":"134","DOI":"10.11604\/pamj.2017.28.134.12444","article-title":"Appraisal of primary health care services in federal Capital Territory, Abuja, Nigeria: how committed are the health workers?","volume":"28","author":"Obembe","year":"2017","journal-title":"Pan Afr Med J"},{"key":"2021080308551763000_9.3.e000994.27","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/phcfm.v8i1.1057","article-title":"Western Cape primary care assessment tool (PCAT) study: measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)","volume":"8","author":"Bresick","year":"2016","journal-title":"Afr J Prim Health Care Fam Med"},{"key":"2021080308551763000_9.3.e000994.28","unstructured":"Aregbeshola B . Towards universal primary health care in Nigeria. In: socialprotection.org [Internet], 2019. Available: https:\/\/socialprotection.org\/discover\/blog\/towards-universal-primary-health-care-nigeria [Accessed 31 Jul 2020]."},{"key":"2021080308551763000_9.3.e000994.29","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2018.1535031","article-title":"Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in south-east Nigeria","volume":"11","author":"Ogbuabor","year":"2018","journal-title":"Glob Health Action"},{"key":"2021080308551763000_9.3.e000994.30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.healthpol.2010.07.013","article-title":"Advocacy for free maternal and child health care in Nigeria\u2014Results and outcomes","volume":"99","author":"Okonofua","year":"2011","journal-title":"Health Policy"},{"key":"2021080308551763000_9.3.e000994.31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-018-1708-2","article-title":"The effect of Kenya\u2019s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities","volume":"18","author":"Gitobu","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2021080308551763000_9.3.e000994.32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-018-2074-9","article-title":"Multilevel analysis of factors associated with assistance during delivery in rural Nigeria: implications for reducing rural-urban inequity in skilled care at delivery","volume":"18","author":"Solanke","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2021080308551763000_9.3.e000994.33","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.39.5.977"},{"key":"2021080308551763000_9.3.e000994.34","first-page":"71","article-title":"Quality of antenatal services at the primary care level in Southwest Nigeria","volume":"12","author":"Oladapo","year":"2008","journal-title":"Afr J Reprod Health"},{"key":"2021080308551763000_9.3.e000994.35","doi-asserted-by":"publisher","DOI":"10.4103\/0300-1652.129653"},{"key":"2021080308551763000_9.3.e000994.36","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4314\/ejhs.v24i0.8S","article-title":"A meta-analysis of socio-demographic factors predicting birth in health facility","volume":"24 Suppl","author":"Berhan","year":"2014","journal-title":"Ethiop J Health Sci"},{"key":"2021080308551763000_9.3.e000994.37","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1080\/23288604.2016.1234861","article-title":"Assessment of primary health care system performance in Nigeria: using the primary health care performance indicator conceptual framework","volume":"2","author":"Kress","year":"2016","journal-title":"Health Syst Reform"},{"key":"2021080308551763000_9.3.e000994.38","first-page":"26","article-title":"The Bamako initiative","volume":"50","author":"Pangu","year":"1997","journal-title":"World Health"},{"key":"2021080308551763000_9.3.e000994.39","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-018-0814-0"},{"key":"2021080308551763000_9.3.e000994.40","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2179-2","article-title":"Evaluating the sub-national fidelity of national initiatives in decentralized health systems: integrated primary health care governance in Nigeria","volume":"17","author":"Eboreime","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2021080308551763000_9.3.e000994.41","first-page":"47","article-title":"State primary health care management boards or agencies: micromanagement or strengthening local government authority capacity?","volume":"38","author":"Asoka","year":"2016","journal-title":"Afr Health: Nigeria"}],"container-title":["Family Medicine and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/fmch-2021-000994","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T16:33:06Z","timestamp":1628008386000},"score":1,"resource":{"primary":{"URL":"https:\/\/fmch.bmj.com\/lookup\/doi\/10.1136\/fmch-2021-000994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,8,3]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/fmch-2021-000994"],"URL":"https:\/\/doi.org\/10.1136\/fmch-2021-000994","relation":{},"ISSN":["2305-6983","2009-8774"],"issn-type":[{"value":"2305-6983","type":"print"},{"value":"2009-8774","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}