Table 2 Barriers to access to care in MNCH service domains by income level of the country and adopted solutions

Community engagement^ȸ

Messaging system ^ȸ

Diminished trust^{¶ ȸ}

Community outreach

Disruption of services ^{¶ ȸ}

Inadequate/limited personnel ^{¶ ȸ}

Financial restrictions ^{ɸ ȸ}

Redirection of resources ^{ɸ ȸ}

Community uninvolved^¶c

Limited access to community support ^{¶ c}

Measures to deter gathering^¶ c

Limited information on vaccination and ANC awareness^¶c

Empowerment community midwives ^ȸ

Encouraging care-seeking behaviors^ȸ

Early recognition of danger signs ^c

Use of technology ^c

Mobile clinics ^c

Partnership and collaborations^ȸ

Community outreach to strengthen via midwives^ȸ

Refugee-centered care ^c

Support groups ^c

Flexibility in guidelines^c

Guidelines in different languages^c

Community outreach^ȸ

Perception of new Ebola or COVID-19 guidelines ^ɸ ȸ

Mobility restrictions ^{§ c}

Communication media ^{§ c}

No translator/community support ^ɸc

New attendance policies restricted access^ɸc

Antenatal care

Paucity of healthcare personnel ^{¶ ȸ}

Insufficient resources ^¶ȸ

Redistribution of resources ^¶

Rigorous Ebola or COVID-19 protocols ^ɸȸ

Culturally attuned care missing – limited availability of female staff ^ɸc

Missed recommended antenatal visits ^ɸȸ

Paucity of healthcare personnel^ȸ

Inadequate infrastructure, lack of supplies as well as PPE^ȸ

Lack of data accuracy^e

Use of technology ^c

Mobile phone applications ^c

Strengthening partnerships ^ȸ

Community outreach^ȸ

Capacity development and training support and empowering health workforce^e

Enhance rural health services^e

Refugee-centered care^c

Encouraging facility delivery^ȸ

Community messaging ^ȸ

Virtual family interactions^c

Community outreach^ȸ

Birth at home preferred/more trust on traditional practices at the time of pandemic¶^ȸ

Lack of information on comprehensive services^{§ ȸ}

Interaction with healthcare providers^§ ȸ

Apprehension of contracting Ebola or COVID-19 or Fear of potential COVID-19 exposure^{§ ȸ}

Limited financial resources^{§ ȸ}

Perceived risk of death due to Ebola—information on high case fatality^e

Intrapartum care

Traditional birth attendants available ^{¶ ȸ}

New/modified service delivery model^{ɸ c}

Service disruptions ^{¶ ȸ}

Government lockdown measures ^{§ ȸ}

Culturally attuned care missing – limited availability of female staff ^ɸc

Paucity of healthcare personnel^ȸ

Inadequate infrastructure, lack of supplies as well as PPE^ȸ

Lack of data accuracy^e

An efficient transport system with 24/7 availability^c

Limiting delays in accessing emergency obstetric care ^ȸ

Increasing trust in health workforce ^ȸ

Community outreach^ȸ

Enhance rural health services^e

Refugee-centered approach^c

Mother-physician messaging ^c

Virtual family meetings^c

Community support persons ^c

Community outreach^ȸ

Perception of new Ebola or COVID-19 guidelines^ȸ

Suspended language support^§

Restrictive visitor policies^§

Forcible mother–child separation^§c

Home-delivered newborns rejected for hospital care^¶ c

Perceived risk of death due to Ebola—information on high case fatality^e

Postnatal care

Restricted family or community support^§cc

Hospital-imposed restrictions on visitors^ɸc

Early discharge of postpartum women. ^ɸc

Lack of assistance from trained healthcare professionals ^¶c

Inadequate infrastructure, lack of supplies as well as PPE^ȸ

Lack of data accuracy^e

Strong partnership of health care providers and other MNCH stakeholders ^ȸ

Equity-based approach for displaced populations ^c

Enhance rural health services^e

Suspension of community outreach programs and campaigns. ^¶

Vaccination

Limited childhood vaccination services. ^¶ȸ

Added burden on routine staff^¶c

Suspension of services^¶ȸ

Surge of vaccine-preventable diseases ^¶ȸ

Improvement in vaccination uptake ^ȸ

Rollout of new vaccines ^c

Interventions tailored to the needs of displaced populations. ^c

Ebola and COVID-19 related restrictions ^§ ȸ

Low utilization of services ^{¶ ȸ}

Childhood illnesses

Decrease in consultation visits ^¶ c

Virtual appointments decreased motivation^c

Interventions tailored to the needs of displaced populations. ^c

Restrictions at facility ^{ɸ ȸ}

Low service utilization^¶ȸ

Lack of trust in health services or health workforce^e

Perceived risk of death due to Ebola—information on high case fatality^e

Family planning

Modified service delivery methods ^ɸc

Transition to virtual provision ^ɸc

Limited availability of long-term postpartum contraceptives ^ɸc

Limited information for informed decisions ^ɸc

Suspension of services^e

Supplies shortage^e

Lack of trust in health services or health workforce^e

Virtual communication

Refugee-centered approaches. ^c

Lack of communication medium and support^{¶ c}

Nutrition

Restricted access to screening^{¶ c}

Nutrition staff were reassigned^{¶ c}

Reduced enrollment in feeding programs ^{¶ c}

Mobile activity to identify children^c

Community engagement, sensitization, and rebuilding trust^e

Sensitization, and rebuilding trust^e

Lack of trust in health services or health workforce^e

Perceived risk of death due to Ebola—information on high case fatality^e

Overall MNCH

Paucity of healthcare personnel^e

Shortage of essential supplies^e

Inadequate infrastructure, lack of supplies as well as PPE^e

Lack of data accuracy^e

Holistic Crisis Preparedness^e

Capacity development and training support and empowering health workforce^e

Resource availability for essential health services and supplies^e

Enhance rural health services^e