Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link

Introduction: Preventable maternal and newborn mortalities still occur in local communities Kenya since access to healthcare services remains a big challenge. Barriers resource-constrained settings have not been examined adequately literature. The World Health Organization (WHO) has 6 building blocks for strengthening systems that informed this study. This paper examines how user-side institutional factors influence use of Maternal Newborn Healthcare (MNH) Services Matayos sub-County-Busia County. Methods: A mixed method approach, with an ethnographic inquiry descriptive cross-sectional design, was adopted assess MNH Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months health care providers study area were recruited as respondents. total 348 postpartum selected through stratified systematic random sampling survey. Purposive used select women, conventional traditional 16 in-depth interviews 7 focus group discussions. Data analyzed using inferential statistics. Qualitative data analysis done thematically. Results: Institutional delivery low at 68% family planning 75% although demand high 99%. User-side barriers included shared beliefs practices community; direct transport costs from home; missing drugs other supplies hospitals. Middle (5th-7th) order deliveries occurred home birth attendants. choice place households influenced by spouses respondents residence where lived or married. All WHO system weak sub-County needed system-wide involving all pillars. user-community voice alone insufficient 7th pillar engagement absent. underlying governance underfunding healthcare. Conclusion: six inadequate due funding. User-community engagement, Pillar, absent these resource-limited settings. We recommend empowerment, participation, adoption thinking approach adequate