Health system responsiveness for maternal healthcare services in East Africa: a mixed-methods systematic review

Health system responsiveness (HSR) is the ability to respond to universal legitimate expectations of service consumers. This contributes to achieving short and long-term health sector goals, such as universal health coverage. However, no comprehensive summary of evidence exists on how HSR can achieve universal maternal health services. Therefore, we aim to examine the successes, challenges, and strategies of HSR toward universal maternity care in East Africa using a mixed-methods systematic review.

We conducted a mixed-methods systematic review of studies published from 1 January 2020 to 8 June 2024. Articles were searched using six databases: Medline, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest. We used three main search terms: HSR, maternal health, and East Africa. A mixed-methods appraisal tool (MMAT) was used to assess the quality and methodological validity of the studies. We then analysed and synthesised the data using the World Health Organization (WHO) HSR framework components.

A total of 72 articles (23 quantitative, 15 mixed-method, and 34 qualitative articles) were included. This review revealed that the responsiveness of obstetric services ranged from 45.8 to 75.6%. Challenges contributing to poor HSR, include limited decision-making autonomy, breaches of confidentiality, non-dignified care, poor communication, delay in care, and unhygienic maternity care. However, maintaining confidentiality, providing abuse-free care, permitting companions, and ensuring informed consent improved responsiveness of maternity care.

The included studies reported wide ranges of the overall HSR and its specific domains for maternity care. Unresponsive health system remains a significant challenge for achieving universal access to maternal healthcare services. As such, HSR continues to hinder quality of maternal healthcare and its utilisation. Ensuring responsive maternity services requires continuous attention from policymakers, managers, and healthcare providers. Strengthening HSR will promote inclusive, effective, and respectful care that safeguards women's rights and ensures equitable care regardless of their circumstances.