scholarly journals Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

2019 ◽  
Vol 24 (S1) ◽  
pp. 31-38 ◽  
Author(s):  
Ashish KC ◽  
Dipendra Raman Singh ◽  
Madan Kumar Upadhyaya ◽  
Shyam Sundar Budhathoki ◽  
Abhishek Gurung ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Facility ◽  
Newborn Care ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Health Facilities ◽  
Care Services ◽  
Quality Of Delivery ◽  
Maternal And Newborn

Abstract Introduction Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. Methods Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities. Results Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. Conclusions These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

scholarly journals Effectiveness of Essential Health Care Services Delivery in Nepal

1970 ◽  
Vol 6 (2) ◽  
pp. 74-83 ◽  
Author(s):  
B Devkota
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Services ◽  
Health Facility ◽  
Health Care Services ◽  
Health Facilities ◽  
Care Services ◽  
Services Delivery ◽  
Equity And Efficiency

Background: Ensuring delivery of quality health services in a sustainable and equitable manner is a challenge in Nepal. A host of factors may have impeded the access, quality and utilization of the health services particularly by the marginalized and disadvantaged sections of the population. Review essential health care services (EHCS) provided by the public health facilities, level of progress, effectiveness, sustainability, equity and efficiency, quality of care and inclusion of marginalized and disadvantaged populations in health care servicesMethods: A total of 40 VDCs from 10 districts representing five regions and three eco-zones were covered. Altogether 800 mothers with under two year children, 40 health service providers, 145 key informants and 40 exit clients were interviewed. Forty focused group discussions were also conducted. From each district, health records of one hospital, PHCC, HP, SHP and Ayurvedic health facility each were collected.Results: More than two-third (68.2%) of the mothers received antenatal checks, highest in hills (85%) followed by terai (64.5%) and mountain districts (52.8%).Tetanus vaccine coverage (80.7%) seems higher compared to Nepal Demographic Health Survey 2001 (45%). FP use rate in mountain, hill and terai are 57.6%, 54.1% and 49.7%, higher than in DoHS 2003/2004 statistics, which were 26.8%, 36.4% and 45.3% respectively. Nine out of ten patients visiting the health facilities were outpatients. The coverage of DPT 3, Polio 3, BCG and measles are 92.8%, 93.4%, 95.2% and 90.7% respectively. From the service utilization perspective, disparities in terms of gender, ecological regions, season of the year and health facility were revealed.Conclusion: Health sector services are yet to be made responsive to the ecological and district specific health problems, and be made more inclusive linking with doable safety nets.  Key words: Essential health care services; Effectiveness; Sustainability; Equity and efficiency; Quality of care and inclusion  doi: 10.3126/jnhrc.v6i2.2188Journal of Nepal Health Research Council Vol. 6 No. 2 Issue 13 Oct 2008 Page: 74-83 

scholarly journals Context Specific Realities and Experiences of Nurses and Midwives in Basic Emergency Obstetric and Newborn Care Services in Two District Hospitals in Rwanda

2021 ◽  
Author(s):  
Aurore Nishimwe ◽  
Daphney Nozizwe Conco ◽  
Marc Nyssen ◽  
Latifat Ibisomi
Keyword(s):  
Quality Of Care ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Obstetric Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
District Hospitals ◽  
Nurses And Midwives

Abstract Background In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into the experiences of these healthcare workers in managing obstetric care emergencies are critical for improving quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. This is a qualitative part of a broader research about implementation of an mLearning and mHealth decision support tool (Safe Delivery Application), in basic emergency obstetric and newborn care services in Rwanda. Methods In this exploratory qualitative aspect of the research, the first author facilitated four focus group discussions with 26 nurses and midwives from two district hospitals in Rwanda. Each focus group discussion was made up of two parts. The first part focused on the participants’ reflections on the research results, while the second part explored their experiences of delivering obstetric care services in their respective district hospitals. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are presented under two broad themes: (1) self-reflections on their current practices and (2) contextual factors influencing the delivery of BEmONC services. Conclusion The insights of nurses and midwives regarding the management of birth related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on their management of PPH and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health particularly in low and middle income countries.

Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi

2008 ◽  
Vol 13 (5) ◽  
pp. 687-694 ◽  
Author(s):  
Eugene J. Kongnyuy ◽  
Jan Hofman ◽  
Grace Mlava ◽  
Chisale Mhango ◽  
Nynke van den Broek
Keyword(s):  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Care Services

scholarly journals Quality of Maternal and Newborn Health Care in Ethiopia: A Cross-Sectional Study

2021 ◽  
Author(s):  
Abera Biadgo ◽  
Aynalem Legesse ◽  
Abiy Seifu ◽  
Kavita Singh ◽  
Zewdie Mulissa ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Newborn Health ◽  
Health Facilities ◽  
Maternal And Newborn Health ◽  
Neonatal Health ◽  
Input Process ◽  
Maternal And Neonatal Health ◽  
Maternal And Newborn

Abstract Background: Despite reports of universal access to and modest utilization of maternal and newborn health services in Ethiopia, mothers and newborns continue to die from preventable causes. Studies indicate this could be due to poor quality of care provided in health systems. Evidences show that high quality health care prevents more than half of all maternal deaths. In Ethiopia, there is limited knowledge surrounding the status of the quality of maternal and newborn health care in health facilities. This study aims to assess the quality of maternal and neonatal health care provision at the health facility level in four regions in Ethiopia.Methodology: This study employed a facility-based cross-sectional study design. It included 32 health facilities which were part of the facilities for prototyping maternal and neonatal health quality improvement interventions. Data was collected using a structured questionnaire, key informant interviews and record reviews. Data was entered in Microsoft Excel and exported to STATA for analysis. Descriptive analysis results are presented in texts, tables and graphs. Quality of maternal and neonatal health care was measured by input, process and outputs components. The components were developed by computing scores using standards used to measure the three components of the quality of maternal and neonatal health care.Result: The study was done in a total of 32 health facilities: 5 hospitals and 27 health centers in four regions. The study revealed that the average value of the quality of the maternal and neonatal health care input component among health facilities was 62%, while the quality of the process component was 43%. The quality of the maternal and neonatal health output component was 48%. According to the standard cut-off point for MNH quality of care, only 5 (15.6%), 3 (9.3%) and 3 (10.7%) of health facilities met the expected input, process and output maternal and neonatal health care quality standards, respectively.Conclusion: This study revealed that the majority of health facilities did not meet the national MNH quality of care standards. Focus should be directed towards improving the input, process and output standards of the maternal and neonatal health care quality, with the strongest focus on process improvement.

scholarly journals Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it?

2019 ◽  
Author(s):  
Keith Tomlin ◽  
Della Berhanu ◽  
Meenakshi Gautham ◽  
Nasir Umar ◽  
Joanna Schellenberg ◽  
...  
Keyword(s):  
Low Income ◽  
Quality Care ◽  
Newborn Care ◽  
Uttar Pradesh ◽  
Routine Care ◽  
Health Facilities ◽  
Signal Functions ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Abstract Background Good quality maternal and newborn care at primary health facilities is essential for both mothers and infants, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality, to assess the quality of routine maternal and newborn care and the proportion of women delivering in facilities with a good standard of care. Surveys were conducted in 2012 and 2015 to assess changes in the quality of care over time. Methods Surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. 166 and 305 primary care facilities were sampled in 2012 and 2015 respectively. In each year we assessed whether each facility could provide four “signal” functions of routine maternal and newborn care. From facility registers we counted the number of deliveries in the previous six months and calculated the proportion of women giving birth in facilities which could offer good quality routine care. Results In Ethiopia the proportion of deliveries in facilities which provided all four signal functions rose from 40% (95% CI 26-57) in 2012 to 43% (95% CI 31-56) in 2015. In Uttar Pradesh in 2012 an estimated 4% (95% CI 1-24) of facility deliveries occurred in facilities which provided all four signal functions, rising to 39% (95% CI 25-55) in 2015. In Nigeria these estimates were 25% (95% CI 6-66) and zero for 2012 and 2015 respectively. Improvements in signal functions in Ethiopia and Uttar Pradesh were led by improved supplies of commodities while Nigeria experienced declines in supplies of commodities and the number of Skilled Birth Attendants employed. Conclusions This study quantifies how health facilities can provide sub-optimal maternal and newborn care, and may help explain inconsistent outcomes of health facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of the capacity of facilities to provide such care. Incorporating data on facility deliveries and repeating the analyses highlights the adjustments that could have greatest impact upon maternal and newborn care.

scholarly journals Quality of maternal and newborn healthcare services in two public hospitals of Bangladesh: identifying gaps and provisions for improvement

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Taposh Kumar Biswas ◽  
Hasnat Sujon ◽  
M. Hafizur Rahman ◽  
Henry B. Perry ◽  
Mahbub Elahi Chowdhury
Keyword(s):  
Public Health ◽  
Service Delivery ◽  
Healthcare Service ◽  
Infection Prevention ◽  
Health Facilities ◽  
Quality Monitoring ◽  
Public Health Facilities ◽  
Care Services ◽  
Maternal And Newborn

Abstract Background Healthcare service delivery systems need to ensure standard quality of care (QoC) for achieving expected health outcomes. Although Bangladesh has a good healthcare service delivery system, there are major concerns about the quality of maternal and newborn health (MNH) care services, which is imperative for achievements in health. The study aimed to measure the QoC for different MNH services in two selected public health facilities of Bangladesh. This study also documented the specific areas of each care which needs intervention. Methods The study was conducted in two district-level public health facilities—a district hospital (DH) and a mother and child welfare centre (MCWC). A total of 228 cases of MNH services were observed by using contextualized checklist ‘Standards-based Management and Recognition (S-BMR)’ for 8 selected MNH care services. For scoring, performed activities were calculated as percentages of the total recommended activities and categorized as high (> 80%), moderate (50 to 80%), and low (< 50%). Results Overall QoC scores were moderate for each DH (54.8%), and MCWC (56.1%). In DH, the QoC score was high for blood transfusion (80.3%); moderate for maternal complications management (77.0%), caesarean section (CS) (65.6%), infection prevention (64.3%), sick newborn care (54.1%), and normal vaginal delivery (NVD) (52.6%); and low for antenatal care (ANC) (25.6%) and postnatal care (PNC) (19.0%). In MCWC, the QoC scores were high for infection prevention (83.0%); moderate for CS (76.5%) and NVD (59.8%); and low for ANC (36.9%) and PNC (24.5%). Conclusions In the study facilities, the QoC for MNH services is found to be unsatisfactory, particularly for ANC and PNC. Urgent initiative needs to be taken by introducing contextualized quality monitoring tools at health facilities, along with training of the care providers and introducing a quality monitoring system.

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