Evidence brief: Barriers to healthcare access among women in sub-Saharan Africa: A pooled analysis of multi-country DHS data (2019–2023)

Abstract

Barriers to accessing healthcare have significantly contributed to the high rates of maternal and child mortality and morbidity in developing regions, particularly in Sub-Saharan Africa. Access to healthcare is influenced by multiple factors, including financial constraints, geographic location, the availability of services, and the quality of care provided. This study aimed to assess the magnitude of these barriers and to identify the factors influencing healthcare access among women of reproductive age in Sub-Saharan Africa.

This study utilized secondary data from the most recent Demographic and Health Surveys conducted between 2019 and 2023 across Sub-Saharan Africa. A weighted sample of 134,470 women of reproductive age was included in the analysis. Data were analyzed using Stata version 14, employing a multilevel mixed-effects logistic regression model. Factors associated with barriers to healthcare access were considered statistically significant at P-values less than 0.05. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to interpret the results.

In this study, the prevalence of barriers to healthcare access among women found to be 55.84% (95% CI:55.57, 56.10). Husband educational status (AOR=1.23, 95% CI: 1.15, 1.30), media exposure (AOR=1.17, 95% CI: 1.11, 1.24), antenatal care visit (AOR=1.31,95% CI: 1.10, 1.55), delivery place (AOR=1.33, 95% CI:1.24, 1.43), health insurance (AOR=1.18, 95% CI: 1.11, 1.26), wealth index(AOR=2.29, 95% CI 2.14, 2.45), (AOR=1.57, 95CI: 1.46, 1.68) and visiting health facility within the past 12 months (AOR=0.91,95% CI:0.87, 0.97) were individual level factors associated with outcome variable. In addition, place of residence (AOR=1.30, 95% CI:1.22, 1.39), community literacy level (AOR=1.13, 95% CI:1.03, 1.24), community poverty level (AOR=1.12, 95% CI:1.02, 1.22), and Region were community level factors associated with barriers to healthcare access.

In this study, over half of women in Sub-Saharan Africa face significant barriers to healthcare access. Educational status, media exposure, place of residence, antenatal care attendance, place of delivery, health insurance coverage, wealth index, recent visits to health facilities, community literacy levels, community wealth status, and regional differences were determinant factors. These findings highlight the need for Sub-Saharan African governments to prioritize these determinants when formulating policies and strategies aimed at reducing preventable barriers to healthcare access in the region.

Introduction

Access to healthcare is broadly defined as the ability to prevent illness, disability, and premature death, to promote and maintain health, and to attain health equity, particularly for women of reproductive age, by offering inclusive, high-quality care and the best possible availability, affordability, and accessibility of medical services [1–3]. Reproductive-age women’s health is a critical global public health concern since it influences population health outcomes and fosters socioeconomic growth [4]. The advancement of socioeconomic development is significantly influenced by the health of women of reproductive age, especially in Africa [5]. The Sustainable Development Goals (SDGs) place a strong emphasis on women’s health, with Targets 3.7 and 3.8 of SDG 3 specifically focusing on achieving universal health coverage by 2030 and ensuring access to sexual and reproductive health services, including education and information on family planning [6,7]. The Sustainable Development Goals (SDGs) explicitly target a substantial reduction in maternal mortality, with Goal 3.1 aiming to lower the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030. While these global efforts have contributed to some improvements in women’s health outcomes, they have yet to fully address the root causes of maternal mortality. Achieving sustained and comprehensive progress remains a critical challenge. In 2016, Sub-Saharan Africa accounted for a disproportionately high share of the 303,000 maternal deaths reported globally, the majority of which were due to preventable causes. Moreover, non-communicable diseases continue to contribute significantly to female morbidity and mortality across nearly all countries, with a particularly severe impact in low- and middle-income settings, where many women are left with long-term disabilities [4–6]. Access to healthcare involves multiple dimensions, including financial affordability, geographic accessibility, availability of medical services, and the quality of care provided in health facilities [8]. Access to healthcare is a key determinant of whether individuals utilize health services. Globally, approximately 400 million people lack essential healthcare, and around eight million die each year from preventable diseases—resulting in an estimated economic loss of $6 trillion in low- and middle-income countries [6,9,10]. In 2015, world leaders pledged to achieve universal health coverage as part of the Sustainable Development Goals (SDGs), aiming to ensure access to affordable, high-quality medicines and financial protection for all [11,12]. In 2017, the World Bank and WHO reported that half of the global population lacks access to essential health services. As a result, many countries in Sub-Saharan Africa have made universal healthcare a key part of their national health strategies. However, there has been slow progress in turning this commitment into tangible results, particularly in securing national funding for equitable, high-quality healthcare, financial security, and overall health [6,9,13,14]. Reproductive age women and child mortality from low family planning uptake, unsafe abortion practices, unintended pregnancies, and an increase in home births are all implications of women in reproductive age having trouble accessing health care [14]. Previous research has offered some evidence regarding the sociodemographic and economic factors that can be barriers to accessing healthcare, such as marital status, place of residence, maternal age, wealth index, educational attainment, and unemployment status. Nevertheless, women of reproductive age continue to face significant disparities in healthcare access and Post-COVID-19 evidence on healthcare access remains limited, particularly in low-resource settings; this study addresses gap by leveraging recent DHS data to examine regional disparities, intersectional demographics, and implications for health system recovery and healthcare access [10,14–16]. This study makes three unique contributions to the body of existing literature. In order to provide a current and policy-relevant analysis of the barrier to healthcare access, it first makes use of the most recent 2019–2023Demographic and Health Survey (DHS) data. Second, our analysis takes a harmonized multi-country approach across ten sub-Saharan African nations, improving cross-national comparability and generalizability in contrast to many previous studies that are limited to single-country analyses or rely on older datasets. In order to gain a better understanding of the structural and contextual factors that influence healthcare access, the study employs a comprehensive multilevel analysis of determinants at the individual and community levels. These contributions put our research in a position to guide focused, empirically supported programs provide fair access to healthcare for reproductive age women in sub-Saharan. Therefore, this study aimed to ascertain the magnitude and potential contributing factors associated with barriers to healthcare access among reproductive age women in sub-Saharan Africa.