scholarly journals “We have either obsolete knowledge, obsolete equipment or obsolete skills”: policy-makers and clinical managers’ views on maternal health delivery in rural Nigeria

2021 ◽  
Vol 9 (3) ◽  
pp. e000994
Author(s):  
Ogochukwu Udenigwe ◽  
Friday E Okonofua ◽  
Lorretta F C Ntoimo ◽  
Wilson Imongan ◽  
Brian Igboin ◽  
...  
Keyword(s):  
Maternal Health ◽  
Service Delivery ◽  
Primary Healthcare ◽  
Health Service Delivery ◽  
Maternal Health Service ◽  
Policy Makers ◽  
Specific Criterion ◽  
Key Informants ◽  
Rural Nigeria ◽  
Edo State

ObjectiveThe objective of this paper is to explore policy-makers and clinical managers’ views on maternal health service delivery in rural Nigeria.DesignThis is a qualitative study using key informant interviews. Participants’ responses were audio recorded and reflective field notes supplemented the transcripts. Data were further analysed with a deductive approach whereby themes were organised based on existing literature and theories on service delivery.SettingThe study was set in Esan South East (ESE) and Etsako East (ETE), two mainly rural local government areas of Edo state, Nigeria.ParticipantsThe study participants consisted of 13 key informants who are policy-makers and clinical managers in ESE and ETE in Edo state. Key informants were chosen using a purposeful criterion sampling technique whereby participants were identified because they meet or exceed a specific criterion related to the subject matter.ResultsRespondents generally depicted maternal care services in primary healthcare centres as inaccessible due to undue barriers of cost and geographic location but deemed it acceptable to women. Respondents’ notion of quality of service delivery encompassed factors such as patient-provider relationships, hygienic conditions of primary healthcare centres, availability of skilled healthcare staff and infrastructural constraints.ConclusionThis study revealed that while some key aspects of service delivery are inadequate in rural primary healthcare centres, there are promising policy reforms underway to address some of the issues. It is important that health officials advocate for strong policies and implementation strategies.

scholarly journals Informal social accountability in maternal health service delivery: A study in Northern Malawi

PLoS ONE ◽  
2018 ◽  
Vol 13 (4) ◽  
pp. e0195671 ◽  
Author(s):  
Elsbet Lodenstein ◽  
Christine Ingemann ◽  
Joyce M. Molenaar ◽  
Marjolein Dieleman ◽  
Jacqueline E. W. Broerse
Keyword(s):  
Maternal Health ◽  
Health Service ◽  
Service Delivery ◽  
Health Service Delivery ◽  
Social Accountability ◽  
Maternal Health Service

scholarly journals The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeanette L. Kaiser ◽  
Rachel M. Fong ◽  
Thandiwe Ngoma ◽  
Kathleen Lucile McGlasson ◽  
Godfrey Biemba ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health Service Delivery ◽  
Health Centers ◽  
Maternal Health Service ◽  
Intervention Site ◽  
Maternity Waiting Homes ◽  
Site Staff ◽  
Rural Health Centers ◽  
Rural Zambia ◽  
And Control

Abstract Background Maternity waiting homes (MWHs) are a potential strategy to address low facility delivery rates resulting from access-associated barriers in resource-limited settings. Within a cluster-randomized controlled trial testing a community-generated MWH model in rural Zambia, we qualitatively assessed how MWHs affect the health workforce and maternal health service delivery at their associated rural health centers. Methods Four rounds of in-depth interviews with district health staff (n = 21) and health center staff (n = 73) were conducted at intervention and control sites over 24 months. We conducted a content analysis using a mixed inductive-deductive approach. Data were interpreted through the lens of the World Health Organzation Health Systems Framework. Results Nearly all respondents expressed challenges with understaffing and overwork and reported that increasing numbers of facility-based deliveries driven by MWHs contributed substantively to their workload. Women waiting at MWHs allow staff to monitor a woman’s final stage of pregnancy and labor onset, detect complications earlier, and either more confidently manage those complications at the health center or refer to higher level care. District, intervention, and control site respondents passionately discussed this benefit over all time points, describing it as outweighing challenges of additional work associated with MWHs. Intervention site staff repeatedly discussed the benefit of MWHs in providing a space for postpartum women to wait after the first few hours of clinical observation through the first 48 h after delivery. Additionally, intervention site staff perceived the ability to observe women for longer before and after delivery allowed them to better anticipate and plan their own work, adjust their workloads and mindset accordingly, and provide better and more timely care. When understaffing and overwork were frequently discussed, this satisfaction in providing better care was a meaningful departure. Conclusions MWHs may benefit staff at rural health centers and the health system more broadly, allowing for the provision of more timely and comprehensive obstetric care. We recommend future studies consider how MWHs impact the workforce, operations, and service delivery at their associated health facilities. Considering the limited numbers of skilled birth attendants available in rural Zambia, it is important to strategically select locations for new MWHs. Trial registration Clinicaltrials.gov, NCT02620436. Registered December 3, 2015, https://clinicaltrials.gov/ct2/show/NCT02620436

scholarly journals The State of Health in Pakistan: An Overview

2013 ◽  
Vol 18 (Special Edition) ◽  
pp. 233-247 ◽  
Author(s):  
Uzma Afzal ◽  
Anam Yusuf
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Sector ◽  
Health Indicators ◽  
Health Service Delivery ◽  
World Health ◽  
Double Burden ◽  
Out Of Pocket Payments

Although the Millennium Development Goals provide countries with wellrounded objectives for achieving human development over a period of 25 years, Pakistan is not on track to achieving the health-related goals. With the eighth highest newborn death rate in the world, in 2001–07 one in every ten children born in Pakistan died before reaching the age of five. Similarly, women have a 1 in 80 chance of dying of maternal health causes during reproductive life. Compared to other South Asian countries, Pakistan currently lags behind in immunization coverage, contraceptive use, and infant and child mortality rates. Expenditure as a percentage of private expenditure on health is about 98 percent, positioning Pakistan among those countries with the highest share of out-of-pocket payments relative to total health expenditure (World Health Organization, 2009). Pakistan is also going through an epidemiological transition where it faces the double burden of communicable diseases combined with maternal and perinatal conditions, as well as chronic, noninfectious diseases. The landscape of public health service delivery presents an uneven distribution of resources between rural and urban areas: The rural poor are at a clear disadvantage in terms of primary and tertiary health services, and also fail to benefit fully from public programs such as the immunization of children. The poor state of public facilities overall has contributed to the diminished role of public health facilities, while the private sector’s role in the provision of service delivery has increased enormously. Following the 18th Amendment to the Constitution, the health sector has been devolved to the provinces, but the distribution of responsibilities and sources of revenue generation between the tiers remains unclear. A multipronged national health policy is needed that tackles the abysmal child and maternal health indicators, and reduces the burden of disease. Moreover, it is imperative to improve the provision of primary and tertiary healthcare with a strong monitoring system in place.

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