Factors influencing efficacy of provision of maternal and reproductive health care:
a qualitative analysis of extra-governmental organizations in Nairobi, Kenya
Background: Maternal mortality is a global health epidemic with crippling economic and social consequences. It impacts women, their families and communities alike. The death of a mother increases the risk of child mortality, decreases the likelihood that surviving children will finish school, and creates a financial burden, as the family must somehow make up the income brought in by the mother and the hours of housework she completes. Many factors, such as overburdened health care systems and government corruption, prevent governments from giving the issue the attention it deserves, especially in the low-income world. As a result, extra-governmental organizations often play a key role in the reduction of maternal mortality. Kenya came nowhere near meeting the target reduction set by the United Nations Millennium Development Goals, which aimed for a three-quarter reduction in maternal mortality in all countries. Extra-governmental organizations play a vital role in filling in gaps in access to care. However, there are inefficiencies in the implementation of global health services. Objective: This research aims to identify key aspects within the economics, infrastructure, and social relations of the organization which allow for or hinder the efficacy of extra-governmental organizations working on issues of maternal and reproductive health, which could be used to improve implementation of services. Methods: In this study, a combination of semi-structure interviews and participant observations where used to complete qualitative analyses of five extra-governmental clinics which offer maternal and reproductive health services. These analyses were then compared to identify their successes and failures, and what contributed to those results. Results: Six key sub-themes of successful organizations were identified within the three major thematic areas. Economics included the funding and price of services. Infrastructure included evaluation and client evaluation and identification of client needs. Social relations included education and social interventions.