Which Care-Seekers are Prioritized for Preventive Maternal and Child Health Services in a Low-Resource Setting? - A Vignette Experiment in Rural Guinea-Bissau

Sep 30, 2026

Uploaded by Rizky

Human resource shortages constrain preventive maternal and child health service provision in low-resource settings, requiring ad-hoc rationing at the point of care. Using an experimental vignette design in rural Guinea-Bissau, the study examines how healthcare providers prioritize based on situational, provider-care-seeker, and care-seeker characteristics, alongside performance goals. Multilevel logistic regression analyzes willingness to provide antenatal care and vaccinations under acute facility-level staffing shortfalls.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

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Introduction

Tropical Medicine & International Health RESEARCH ARTICLE OPEN ACCESS Which Care-Seekers are Prioritized for Preventive Maternal and Child Health Services in a Low-Resource Setting? A Vignette Experiment in Rural Guinea-Bissau Anne-Sophie Sparresø Bærentzen1,2 | Kimberly Raisa Nehal1,2 | Demba Pedro Gomes1 | Stéphane Helleringer3 | Ane Bærent Fisker1,2,4 | Sabine Margarete Damerow1,2 1Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau | 2Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark | 3Division of Social Science, Social Research and Public Policy Program, New York University (NYU), Abu Dhabi, UAE | 4Centre for Global Health, University of Southern Denmark, Odense, Denmark Correspondence: Sabine Margarete Damerow ([sdamerow@health.sdu.dk](sdamerow@health.sdu.dk)) Received: 1 May 2025 | Accepted: 2 October 2025 Funding: This work was supported by funding from the Odense University Hospital's Internationalisation Foundation (10216075002), AP Møller Foundation (95-10128-3110280), the Delegation of the European Union to Guinea-Bissau (NDICI AFRICA 2023/442–714), and Novo Nordisk Foundation (Scholarship to ASB, 95-10128-3110320). The work of the the team was further supported by Lundbeck Foundation (Ascending investigator grant to ABF, R313-2019-635) . Keywords: Guinea-Bissau | healthcare providers | health service delivery | human-resource constraints | low-resource setting | maternal and child health | micro-level rationing | rationing in healthcare | vignette experiment ABSTRACT Objectives: Human resource shortages create bottlenecks to preventive maternal and child health service provision in lowresource settings, making ad-hoc service rationing at the point of care necessary. Little is known about how healthcare providers prioritise. We explored healthcare providers' rationing decisions for preventive maternal and child health services in rural Guinea-Bissau through an experimental vignette design considering situational and care-seeker characteristics and performance goals. Methods: We implemented two vignette experiments, one for antenatal care, and one for childhood vaccinations. At 55 health facilities, providers were requested to state their willingness to provide antenatal care/vaccination given a scenario of an acute facility-level human-resource shortage and combinations of contextualised factors, summarised in 16 vignettes per experiment: provider-care-seeker relationship (stranger/related) and distance (close/far) between care-seeker residence and facility (both experiments); gestational age (2nd/3rd trimester) and consultation number (1st/4th) (antenatal care experiment); child age (5/13 months), vaccine sought (Bacillus Calmette-Guérin/3rd Pentavalent vaccine (Penta3)), and number of other children waiting (3/12) (vaccination experiment). We also inquired about facility and interviewee characteristics. Using multilevel logistic regressions, we assessed associations between the factors and providers' stated willingness for each experiment. Results: We interviewed a total of 159 healthcare providers; 112 provided antenatal care, 118 vaccinations. Interviewees in the antenatal care experiment stated willingness for antenatal care provision for 94%(1691/1792) of the vignettes (range across vignettes: 88%–99%) . Last pregnancy trimester, long distance, and providers' work experience were associated with stated increased willingness. In the vaccination experiment, the interviewees stated their willingness to vaccinate for 72%(1357/1887) | Sustainable Development Goal: Good Health and Wellbeing
Anne-Sophie Sparresø Bærentzen and Kimberly Raisa Nehal share joint first authorship.
Ane Bærent Fisker and Sabine Margarete Damerow share joint senior authorship. | | --- | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits us

FAQs

What problem does the study address in low-resource settings?

Human resource shortages create bottlenecks for preventive maternal and child health services, making ad-hoc rationing necessary at the point of care.

How were the providers’ decisions studied?

Two vignette experiments were used—one for antenatal care and one for childhood vaccinations—asking providers about willingness under acute facility-level staffing shortages and varying contextual factors.

Which factors were associated with greater willingness to provide antenatal care?

Last pregnancy trimester, long distance, and providers’ work experience were associated with increased willingness in the antenatal care experiment.

Sep 30, 2026

Uploaded by Rizky