scholarly journals Health system redesign for equity in maternal and newborn health must be codesigned, country led, adapted to context and fit for purpose

2020 ◽  
Vol 5 (10) ◽  
pp. e003748
Author(s):  
Claudia Hanson ◽  
Peter Waiswa ◽  
Andrea Pembe ◽  
Jane Sandall ◽  
Joanna Schellenberg
BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042952
Author(s):  
Solange Mianda ◽  
Olamide O Todowede ◽  
Helen Schneider

IntroductionThis review will explore the characteristics of service delivery-related interventions to improve maternal and newborn health in low-income and middle-income countries, comparing three common framing approaches of these interventions (referred to as archetypes), namely, quality improvement (QI), health system strengthening (HSS) and implementation science (IS), over the last 20 years.Methods and analysisThis study will review the literature on health service interventions from 2000 to 2020. This will be achieved by searching for English peer-reviewed articles in the following electronic databases EBSCOhost, PubMed, Web of Science, MASCOT/Wotro Map of Maternal Health Research and Google scholar. We will develop a systematic search strategy using a combination of keywords and Boolean operators AND/OR. Eligibility screening and data extraction will be conducted by two independent reviewers, and disagreements resolved by a third independent reviewer. Analyses will be conducted in two steps, a quantitative and a qualitative phase. The quantitative phase will provide a descriptive profile of papers, including the category (QI, HSS, IS, mixed or other) of papers. In the follow-up qualitative phase, all three reviewers will independently code for key concepts in a subset of papers, jointly selected as representing each archetype, and analysed in batches until concept saturation is achieved.Ethics and disseminationThis review does not require ethical approval. The results will be published as an article in a peer-reviewed journal and presented to stakeholders involved in implementing health system interventions in maternal and newborn.


Author(s):  
Nathalie Roos ◽  
Sari Kovats ◽  
Shakoor Hajat ◽  
Veronique Filippi ◽  
Matthew Chersich ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Resham B. Khatri ◽  
Yibeltal Alemu ◽  
Melinda M. Protani ◽  
Rajendra Karkee ◽  
Jo Durham

Abstract Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.


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