Looking at maternal health of Asháninka communities from the conceptual framework of the accessibility of care

Abstract

Background: Peru is one of the 20 countries that has significantly reduced maternal mortality before the pandemic due to implementing policies to strengthen maternal health care, mainly in rural areas with greater poverty. However, the implementation of these policies has been different across the territory; such is the case of the indigenous communities of the Peruvian Amazon that are characterized by the inaccessibility of their territory and continue to face severe problems in accessing maternity care in health services. Objective: Analyze the main dimensions of accessibility for maternal care in public health services for women of the Asháninka community of Peru between 2016 and 2018. Methods: Qualitative research was carried out in the Asháninka community of the Tambo River. Key informants involved in maternal health care were selected, and 60 in-depth interviews were conducted that explored geographical, financial, cultural, and organizational accessibility. The interviews were recorded and transcribed into a word processor; then, a content analysis was performed to classify the texts according to the dimensions of specified accessibility. Results: Geographical accessibility: health units in the territory do not have the resolution capacity to attend maternal health problems. Financial accessibility: the programs implemented by the government have not been able to finance the indirect costs of care, such as transportation, which has high costs that a family cannot afford, given their subsistence economy. Cultural: there are efforts for cultural adaptation of maternal care, but its implementation needs to be improved, and the community cannot recognize it due to the lack of continuity of the model and the high personnel turnover. Organizational: health units are characterized by insufficient human resources, supplies, and medicines that fail to offer continuous and quality care. Conclusions: The poor geographical, financial, cultural, and organizational accessibility that women from the Asháninka community face for maternal care in public health services are evident. So, the Peruvian government must review the implementation processes of its models of care and maternal health programs in these communities and propose strategies to improve the coverage, quality and continuity of maternal care.