scholarly journals Health Systems Strengthening Efforts Help to Improve the Delivery of Maternal Nutrition Interventions in Antenatal Care in Uttar Pradesh (UP), India but Gaps Remain

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1314-1314
Author(s):  
Shivani Kachwaha ◽  
Phuong Nguyen ◽  
Lan Mai Tran ◽  
Rasmi Avula ◽  
Melissa Young ◽  
...  
Keyword(s):  
Weight Gain ◽  
Service Delivery ◽  
Antenatal Care ◽  
Health Systems ◽  
Maternal Nutrition ◽  
Health Systems Strengthening ◽  
Nutrition Interventions ◽  
Diet Diversity ◽  
Calcium Supplements ◽  
Diet Supplements

Abstract Objectives Frontline workers (FLWs) deliver essential nutrition services to reduce maternal undernutrition in India, but coverage and quality remain sub-optimal. Alive & Thrive aimed to strengthen delivery of interpersonal counselling, community mobilization and micronutrient supplements through the government antenatal care (ANC) platform in UP. We studied pathways through which the nutrition-intensified ANC (I-ANC) was intended to impact FLWs capacity, knowledge, and service delivery, compared to standard ANC (S-ANC). Methods We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019), ∼500 FLWs per survey. Differences between I-ANC and S-ANC were compared along six impact pathway components (training, availability of materials, supportive supervision, knowledge, service delivery, and counselling content) using mixed-effects regression adjusted for clustering. Results Training exposure was higher in I-ANC than S-ANC (9 percentage points, pp). Nutrition training topics were low-moderate (30–60%) in both arms. Job aids were more available in I-ANC (70–80%) than S-ANC (30–40%). Supply of iron-folate and calcium supplements were low in both arms, with 10–50% having stock-outs. FLWs in I-ANC were more likely to receive supervision visits (7 pp), but gaps remained in both arms. Compared to S-ANC, FLWs in I-ANC had higher knowledge on diet diversity (6 pp), adequate intake (10 pp), iron-folate (10 pp) and calcium supplements (30 pp), pregnancy weight gain (20–30 pp), and early breastfeeding (5 pp), but similarly low knowledge of exclusive breastfeeding. ANC check-ups by FLWs were 20 pp higher in I-ANC. FLWs in I-ANC did more counselling on adequate diet, supplements, and weight gain (10–20 pp). Counselling on diet diversity and breastfeeding were low in both arms. Conclusions Health systems strengthening efforts helped improve the delivery of maternal nutrition interventions in antenatal care in this context, but gaps remain. Several health system elements along the program pathway – supply chain management, training, supervisory practices – require strengthening to further improve FLW knowledge and nutrition service delivery. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

scholarly journals Strengthening Nutrition Interventions in Antenatal Care Services Had Modest Impacts on Diet Diversity, Micronutrient Intake, and Breastfeeding in Uttar Pradesh, India

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1050-1050
Author(s):  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Lan Mai Tran ◽  
Rasmi Avula ◽  
Melissa Young ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Process Evaluation ◽  
Maternal Nutrition ◽  
Dietary Diversity ◽  
System Level ◽  
Food Groups ◽  
Diet Diversity ◽  
Calcium Supplements ◽  
The Impact

Abstract Objectives Interventions to improve maternal nutrition are poorly integrated into antenatal care (ANC) services in India. Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization implemented through government ANC services. We evaluated the impact of nutrition-intensified ANC (I-ANC) compared to standard ANC (S-ANC) on diet diversity, consumption of iron-folic acid (IFA) and calcium supplements, and early breastfeeding practices. Methods We used a cluster-randomized design with cross-sectional surveys at baseline (2017) and endline (2019) (n ∼660 pregnant women and 1800 recently delivered women per survey) and a process evaluation. We derived difference-in-difference effect estimates, adjusted for geographic clustering, gestational age, infant age, and sex. Results Coverage of interventions was high at endline; 70–90% women were contacted by frontline workers at home or nutrition centers. Women in the I-ANC arm were significantly more likely to have received counseling on core nutrition messages (10–18 percentage points [pp]) than those in the S-ANC arm. Dietary diversity improved modestly among pregnant women in the I-ANC arm compared to the S-ANC arm (effect: 8.3 pp). The number of food groups consumed increased slightly over time but remained low in both arms. The percentage of women who consumed 100 + IFA improved equally in both arms (from 8 to 25%). Small significant impacts were observed for any consumption of IFA and calcium supplements (effects 10.3 and 12.4 pp, respectively). Significant impacts were also observed for non-prelacteal feeding (effect: −6.3 pp) and exclusive breastfeeding (effect: 7.4 pp) but not for early initiation of breastfeeding. The process evaluation found that system-level and supply-chain challenges, household context, and local diet preferences affected implementation and uptake. Conclusions Intensifying nutrition in existing government ANC services resulted in modest improvements in maternal nutrition practices. Dietary diversity and consumption of supplements remained sub-optimal. Additional efforts are needed for further improvement of maternal nutrition services. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.

scholarly journals Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India

2021 ◽  
Author(s):  
Tina Sanghvi ◽  
Phuong H. Nguyen ◽  
Manisha Tharaney ◽  
Sebanti Ghosh ◽  
Jessica Escobar‐Alegria ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Burkina Faso ◽  
Maternal Nutrition ◽  
Nutrition Interventions ◽  
Care Services

scholarly journals Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Abhinav Bassi ◽  
Oommen John ◽  
Devarsetty Praveen ◽  
Pallab K Maulik ◽  
Rajmohan Panda ◽  
...  
Keyword(s):  
Health Care ◽  
Service Delivery ◽  
Health System ◽  
Health Systems ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Systems Strengthening ◽  
Noncommunicable Disease ◽  
Health Initiatives

BACKGROUND With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. OBJECTIVE We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. METHODS A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. RESULTS The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. CONCLUSIONS In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.

scholarly journals Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-eastern Nigeria

2020 ◽  
Author(s):  
Daniel Chukwuemeka Ogbuabor
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Health Systems ◽  
Service Providers ◽  
Control Programme ◽  
Health Systems Strengthening ◽  
Factors Affecting ◽  
Tb Control ◽  
South Eastern ◽  
Enugu State

Abstract Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

scholarly journals Missed Opportunities for Maternal Nutrition Interventions During Antenatal Care Visits Persist in Burkina Faso

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1055-1055
Author(s):  
Césaire Ouédraogo ◽  
Sunny Kim ◽  
Rock Zagre ◽  
Rasmané Ganaba ◽  
Maurice Zafimanjaka ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Burkina Faso ◽  
Maternal Age ◽  
Maternal Nutrition ◽  
Household Composition ◽  
Nutrition Intervention ◽  
Nutrition Interventions ◽  
High Coverage ◽  
Missed Opportunities ◽  
Government Health

Abstract Objectives High coverage of any antenatal care (ANC) and near-universal coverage of iron-folic acid (IFA) supplementation is reported by nationally representative surveys in Burkina Faso. We examined the coverage of maternal nutrition interventions during ANC to assess gaps and missed opportunities in achieving global and national recommendations. Methods We used household survey data among 1920 mothers with children <6 months of age in 2 regions in Burkina Faso, collected in November-December 2019. Descriptive statistics were used to examine exposure to nutrition interventions during antenatal care throughout pregnancy and equity analyses were conducted to assess differences in exposure by maternal age (adolescents 15–19 y of age and older mothers) and education (none vs. any schooling). Results All mothers reported having attended at least one ANC visit at a health facility (mostly government health centers) during last pregnancy, but only 66.6% reported attending at least 4 visits. All consumed IFA tablets, but reported consuming 109 tablets on average during pregnancy, which was short of the recommended 180 tablets over 6 months. Only 42.7% reported receiving any nutrition counseling during ANC, with the most common messages reported on consuming one IFA tablet daily (93.4%) and eating a variety of foods (68.8%). While nearly all mothers were weighed during ANC, very few reported receiving information about weight gain. Among mothers, 14% were adolescents below 20 y, and 66.1% never attended school. For all indicators related to exposure to ANC or maternal nutrition intervention, we observed no differences by maternal age, education or other subgroups such as religion, parity or household composition. Conclusions The government health system in Burkina Faso with its widespread and uniform reach provides an opportunity for improving the low coverage of maternal nutrition interventions during ANC. Doing so will require efforts both to improve the coverage of 4 or more ANC visits and the effective integration of nutrition interventions into ANC. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360; and CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute.

scholarly journals Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-eastern Nigeria

2019 ◽  
Author(s):  
Daniel Chukwuemeka Ogbuabor
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Health Systems ◽  
Service Providers ◽  
Control Programme ◽  
Health Systems Strengthening ◽  
Factors Affecting ◽  
Tb Control ◽  
South Eastern ◽  
Enugu State

Abstract Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

scholarly journals Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Kristen Meagher ◽  
Bothaina Attal ◽  
Preeti Patel
Keyword(s):  
Political Economy ◽  
Health Systems ◽  
Armed Conflict ◽  
Narrative Review ◽  
Health Systems Strengthening ◽  
The Political ◽  
Systems Research ◽  
Political Economy Of Health ◽  
And Gender

Abstract Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.

scholarly journals Effects of transition on HIV and non-HIV services and health systems in Kenya: a mixed methods evaluation of donor transition

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniela C. Rodríguez ◽  
Diwakar Mohan ◽  
Caroline Mackenzie ◽  
Jess Wilhelm ◽  
Ezinne Eze-Ajoku ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Service Delivery ◽  
Health Systems ◽  
Local Level ◽  
Health Facilities ◽  
Government Support ◽  
Hiv Care ◽  
Local Context ◽  
Mixed Methods Evaluation ◽  
The Us

Abstract Background In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). Methods We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities. Quantitative data from a facility survey and health service delivery data were gathered and combined with data from two rounds of interviews and focus group discussions (FGDs) conducted at national and sub-national level to document the design and implementation of GP. The survey included 230 health facilities across 10 counties, and 59 interviews and 22 FGDs were conducted with government officials, health facility providers, patients, and civil society. Results We found that PEPFAR moved quickly from announcing the GP to implementation. Despite extensive conversations between the US government and the Government of Kenya, there was little consultation with sub-national actors even though the country had recently undergone a major devolution process. Survey and qualitative data identified a number of effects from GP, including discontinuation of certain services, declines in quality and access to HIV care, loss of training and financial incentives for health workers, and disruption of laboratory testing. Despite these reports, service coverage had not been greatly affected; however, clinician strikes in the post-transition period were potential confounders. Conclusions This study found similar effects to earlier research on transition and provides additional insights about internal country transitions, particularly in decentralized contexts. Aside from a need for longer planning periods and better communication and coordination, we raise concerns about transitions driven by epidemiological criteria without adaptation to the local context and their implication for priority-setting and HIV investments at the local level.

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