Barriers and Facilitators of Access to Maternal, Newborn and Child Health Services During the First Wave of COVID-19 Pandemic in Nigeria: Findings From a Qualitative Study

Abstract BackgroundUnderstanding how COVID-19 has shaped access to maternal. newborn and child health (MNCH) services in Nigeria and the contextual factors attributable to these changes is crucial towards development of policies and interventions that will assist the country in maintaining focus towards sustaining the little gains it has made over the past few years towards improving MNCH despite the COVID -19 pandemic.The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria.MethodsA qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers,) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.ResultsBarriers to accessing MNCH services during the first wave of Covid-19 pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, movement restriction, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services. Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics.Conclusion Access to MNCH services was negatively affected by the COVID-19 pandemic particularly due to challenges resulting from restrictions in movements and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for national health managers and policy makers to institute measures that will allow unhindered access to MNCH services during future pandemics. This may include provision of socio-economic safety nets for women, provision of PPEs, use of e-health platforms for consultations, and incentives for health workers.