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01.12.2015 | Debate | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed

BMC Public Health > Ausgabe 1/2015
Khalifa Elmusharaf, Elaine Byrne, Diarmuid O’Donovan
Wichtige Hinweise

Competing interests

The authors have no conflicting interests to declare.

Authors' contributions

All the authors have made substantial contributions to conception and design, and have been involved in drafting the manuscript or revising it critically for important intellectual content. All the authors have read and approved the final manuscript.

Authors' information

KE is a Lecturer in Epidemiology & Public Health Medicine at Royal College of Surgeons in Ireland, RCSI Bahrain and the Director of Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum – Sudan. EB is the Research Programme Coordinator at the Department of Epidemiology and Public Health Medicine at Royal College of Surgeons in Ireland. DO is a Senior Lecturer in Social & Preventive Medicine, National University of Ireland, Galway and the Director of Public Health, Health Service Executive West, Galway.



Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.


Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented.


We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.
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