scholarly journals Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

2022 ◽  
Vol 7 (1) ◽  
pp. e007247
Author(s):  
Zeus Aranda ◽  
Thierry Binde ◽  
Katherine Tashman ◽  
Ananya Tadikonda ◽  
Bill Mawindo ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Sierra Leone ◽  
Service Use ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Maternal Health Service ◽  
Health Service Use ◽  
The Impact

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

2019 ◽  
Author(s):  
Collins Chansa ◽  
Mulenga Mary Mukanu ◽  
Chitalu Miriam Chama-Chiliba ◽  
Mpuma Kamanga ◽  
Nicholas Chikwenya ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Health Expenditure ◽  
Maternal Health Services ◽  
Health Facilities ◽  
District Level ◽  
Health Service Provision ◽  
Equity Of Access ◽  
The Impact

Abstract Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

scholarly journals Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027822 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Ibukun-Oluwa Omolade Abejirinde ◽  
Oluwasola Banke-Thomas ◽  
Adamu Maikano ◽  
Charles Anawo Ameh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Economic Evaluations ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

scholarly journals Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

2019 ◽  
Vol 34 (2) ◽  
pp. 120-131 ◽  
Author(s):  
Mardieh L Dennis ◽  
Lenka Benova ◽  
Timothy Abuya ◽  
Matteo Quartagno ◽  
Ben Bellows ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Service Use ◽  
Maternal Health Service ◽  
Health Service Use ◽  
Maternal Healthcare ◽  
User Fee

scholarly journals Impact of the COVID-19 pandemic and response on the utilisation of health services in public facilities during the first wave in Kinshasa, the Democratic Republic of the Congo

2021 ◽  
Vol 6 (7) ◽  
pp. e005955
Author(s):  
Celestin Hategeka ◽  
Simone E Carter ◽  
Faustin Mukalenge Chenge ◽  
Eric Nyambu Katanga ◽  
Grégoire Lurton ◽  
...  
Keyword(s):  
Time Series ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Infectious Diseases ◽  
Service Use ◽  
Democratic Republic ◽  
Health Service Use ◽  
Outpatient Visits ◽  
Republic Of The Congo

IntroductionHealth service use among the public can decline during outbreaks and had been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone.MethodsUsing monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (ie, Gombe vs other health zones).ResultsHealth service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lockdown was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.ConclusionThe COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than prepandemic levels.

scholarly journals Maternal health services utilization among mothers in a rural municipality

2021 ◽  
Vol 8 (1) ◽  
pp. 121-131
Author(s):  
Nirmala Ghimire ◽  
Roshani Agrawal Khatry ◽  
Vivechana Shakya
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Rural Municipality ◽  
Good Utilization ◽  
The Government

Introduction: Maternal health is essential to ensure the good health of the mother as well as children and by extension, the whole family. Despite the various measures launched by the government to enhance maternal care services, the utilization remains at large. Method: A community-based face to face interview was conducted using a pre-tested structured survey questionnaire to find out maternal health service utilization among mothers in Mahankal Rural Municipality, Lalitpur, Nepal, during Feb-Jun 2020. A probability simple random sampling was used to select mothers having children aged between 1 to 3 y. A score of  ≥mean was considered good utilization and below it a poor utilization. The study was approved by the ethical committee. The SPSS 16 was used for descriptive (frequency, mean) and comparative analysis by chi square between demographics and health service utilization. Result: There were a total of 178 mothers surveyed, the mean age of 25.9±4.4 y, 77(43.3%) had completed elementary school, and 147(82.6%) were farmers. Good utilization of maternal health service 98(55%) and poor utilization 80(45%). The majority 153(86%) had ≥4 Antenatal checkups, 55(30.9%) had delivered at home despite the government incentive for institutional delivery, 105(59%) had postnatal visits ≥1, and 18(10%) had 3 postnatal visits.   Conclusion: The study revealed that slightly more than half (55%) of mothers surveyed had good utilization of maternal health services.

scholarly journals Impact of the COVID-19 pandemic and response on the utilisation of health services during the first wave in Kinshasa, the Democratic Republic of the Congo

2021 ◽  
Author(s):  
Celestin Hategeka ◽  
Simone Elyse Carter ◽  
Faustin Mukalenge Chenge ◽  
Eric Nyambu Katanga ◽  
Gregoire Lurton ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Infectious Diseases ◽  
Service Use ◽  
Democratic Republic ◽  
Communicable Diseases ◽  
Health Service Use ◽  
Non Communicable Diseases ◽  
Republic Of The Congo

Introduction: Health service use among the general public can decline during infectious disease outbreaks and has been predicted among low and middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) implemented public health measures across Kinshasa, including strict lockdown measures in the Gombe health zone, to mitigate impact of the pandemic. Methods: Using data from the Health Management Information System (January 2018 - December 2020), we evaluated the impact of the pandemic on the use of essential health services (total visits, maternal health, vaccinations, visits for common infectious diseases, and diagnosis of non-communicable diseases) using interrupted time series with mixed effects segmented Poisson regression models during the first wave of the pandemic. Analyses were stratified by age, sex, health facility, and neighbourhood. Results: Health service use dropped rapidly following the start of the pandemic and ranged from 16% for hypertension diagnoses to 39% for diabetes diagnoses. However, reductions were highly concentrated in Gombe (81% decline in total visits) relative to health zones without lockdown. When the lockdown was lifted, total visits, visits for infectious diseases, and diagnoses for non-communicable diseases increased approximately two-fold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected. Conclusion: The COVID-19 pandemic resulted in important reductions in health service utilisation in Kinshasa, particularly Gombe. Lifting of lockdown led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.

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