The impact of training traditional birth attendants on the utilisation of maternal health services.

COVID-19 has spread rapidly in Kenya and has not spared pregnant women. Evidence from Kenya shows that during the COVID-19 pandemic, health systems have been either stressed to their maximum capacity or are becoming overwhelmed. However, the population is advised not to attend hospital unless strictly necessary, and this advice seems to apply to all, including expectant mothers. There is a dearth of information on how poor expectant mothers with low bargaining power cope during COVID-19 in Kenya, which this study addresses for those in Kilifi County. This rapid qualitative study draws data from an extensive literature review and from interviews with 12 purposively selected mothers who were either expectant or had newborn babies during the pandemic in Kilifi County. Five matrons-in-charge of maternal health services and four traditional birth attendants were also interviewed via mobile phone. Data were analyzed thematically and are presented in a textual description. It emerged that expectant mothers feared attending hospitals for perinatal care due to the possibility of contracting COVID-19. Therefore, there was an increase in home deliveries with the assistance of traditional birth attendants (TBAs)/traditional midwives, who were also overwhelmed with women who sought their services. Since most causes of maternal morbidity and mortality can be prevented by prompt, suitable treatment by qualified health practitioners, the health officials interviewed recommended training and integration of TBAs in emergency healthcare responses to help during crises in MHS because they are trusted by their local communities. Notably, such integration of traditional midwives should be supported and should also include additional training and monetary incentives.

Download Full-text

Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Download Full-text

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

Health Policy and Planning ◽

10.1093/heapol/czz130 ◽

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.

Download Full-text

Health Workers’ Perspectives on Infrastructure to Support Maternal Health Services in Rural Areas of Vietnam

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v12i2.81 ◽

2017 ◽

Vol 12 (2) ◽

pp. 55-61

Author(s):

Thi Hoai Thu Nguyen ◽

Fiona McDonald ◽

Andrew Wilson

Keyword(s):

Primary Care ◽

Developing Countries ◽

Maternal Health ◽

Health Services ◽

Rural Areas ◽

Health Workers ◽

Maternal Health Services ◽

District Health ◽

Health Centres ◽

The Impact

Background: One common governance issue faced by developing countries is the establishment and maintenance of infrastructure to support the delivery of primary health services. This qualitative study explores the perspective of maternal health workers on how infrastructure impacts the provision of maternity services in rural areas in Vietnam. Methods: Forty-one health workers and health managers at the commune, district and provincial levels of the Vietnamese public health system were interviewed. Questions focused on the impact of various organisational factors, including the impact of infrastructure on the performance of the health workforce, which provides publicly funded primary care. All interviews were recorded, transcribed and coded for thematic analysis. Findings: Participants noted that infrastructure directly affected their ability to perform certain tasks and could both directly and indirectly negatively impact their motivation. In general, participants noted a lack of investment in infrastructure for the provision of primary care services in rural areas. They identified that there were deficits in the availability of utilities and the adequacy of facilities. Conclusion: This research contributes to understanding the barriers to the provision of primary care in developing countries and in particular. The current inadequacy of facility buildings and inadequacy of clean water supply are issues for health workers in meeting the technical requirements of the standards as set out in the National Guidelines on reproductive health, and lead to safety concerns for the quality of maternal health services provided in commune health centres and District Health Centres. Abbreviations: CHC – Commune Health Centres; DHC – District Health Centre; HW – Health Worker.

Download Full-text

Savings ownership and the use of maternal health services in Indonesia

Health Policy and Planning ◽

10.1093/heapol/czz094 ◽

2019 ◽

Vol 34 (10) ◽

pp. 752-761

Author(s):

Soyoon Weon ◽

David W Rothwell ◽

Shailen Nandy ◽

Arijit Nandi

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Care Delivery ◽

Maternal Health Services ◽

Reproductive Age ◽

Percentage Points ◽

The Impact ◽

Use Of Health Services

Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.

Download Full-text

Geographic access and maternal health services utilization in Sélingué Health District, Mali.

10.21203/rs.3.rs-41254/v1 ◽

2020 ◽

Author(s):

Moctar TOUNKARA ◽

Oumar Sangho ◽

Madeleine Beebe ◽

Lillian Joyce Whiting-Collins ◽

Rebecca R. Goins ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Maternal Mortality ◽

Health Facility ◽

Health Services Utilization ◽

Maternal Health Services ◽

Health District ◽

Geographic Access ◽

Services Utilization ◽

The Impact

Abstract Introduction. Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in high geographic-access regions. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality and denotes a lack of equity in the Malian health system.Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within moderate geographic access districts in Mali. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.Methods. We conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.Results. The majority of the participants were 20 to 24 years old. Over 68% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district impede the other roughly 40% of our sample from utilizing maternal healthcare. The concentration index demonstrated the impact of inequity in geographic access comparing women residing near and far from the referral care facility.Conclusion. Maternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

Download Full-text

Determinants of skilled birth attendants for delivery in Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i3.6223 ◽

2012 ◽

Vol 8 (3) ◽

pp. 325-332 ◽

Cited By ~ 23

Author(s):

Y R Baral ◽

K Lyons ◽

J Skinner ◽

E R Van Teijlingen

Keyword(s):

Qualitative Research ◽

Maternal Health ◽

Health Services ◽

Quantitative Research ◽

Skilled Birth Attendance ◽

Maternal Health Services ◽

Skilled Birth Attendants ◽

Birth Attendants ◽

Birth Attendance ◽

Women's Role

This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women’s role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women’s involvement in decision making; and women’s autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women’s role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery. Qualitative research will help further exploration of the issues and contribute to improvement of maternal health services.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6223 Kathmandu Univ Med J 2010;8(3):325-32

Download Full-text

The association between male involvement in institutional delivery and women’s use of institutional delivery in Debre Tabor town, North West Ethiopia: Community based survey

PLoS ONE ◽

10.1371/journal.pone.0249917 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249917

Author(s):

Kassanesh Melese Tessema ◽

Kebadnew Mulatu Mihirete ◽

Endalkachew Worku Mengesha ◽

Azezu Asres Nigussie ◽

Awoke Giletew Wondie

Keyword(s):

Maternal Health ◽

Health Services ◽

Institutional Delivery ◽

Male Involvement ◽

Maternal Health Services ◽

Maternal Health Service ◽

Male Partners ◽

Community Based ◽

Cross Sectional ◽

The Impact

Background Maternal deaths remain high in Ethiopia mainly due to poor maternal health service utilization. Despite men are the chief decision-makers and economically dominant in Ethiopia, the impact of their involvement on maternal health services utilization is not clear. This study aimed to assess the association between male involvement and women’s use of institutional delivery, and factors influencing male partners’ involvement in institutional delivery. Methods A community based cross-sectional study was conducted between March and May, 2019. A total of 477 married men who have children less than one year of age were interviewed. Face-to-face interviews using a pre-tested and structured questionnaire were used for data collection. Bivariate and multiple logistic regressions were carried out. SPSS version 23 was used for data analysis. Results Overall 181 (37.9%) husbands/partners were involved in institutional delivery for the most recent child birth. Male partners involvement in institutional delivery was strongly associated with an increased odds of attending institutional delivery by spouse [AOR: 66.2, 95% CI: 24.8, 177.0]. Education [AOR: 0.33, 95% CI: 0.18–0.59], knowledge on maternal health [AOR: 1.67, 95% CI: 1.11–2.50], favourable attitude towards institutional delivery [AOR: 1.83, 95% CI: 1.23–2.71], and no fear while supporting spouse [AOR: 2.65, 95% CI: 1.28–5.50] were positively associated with male partners involvement in institutional delivery. Conclusion Male partner’s involvement in institutional delivery was inadequate. This study reported a significant beneficial impact of male involvement on maternal health through improved utilisation of institutional delivery. Therefore, maternal health interventions should target husbands as consumers of maternal health services, and healthcare/government policies that isolate or discourage men from having active engagement in maternal health should be improved.

Download Full-text

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

BMJ Global Health ◽

10.1136/bmjgh-2021-007247 ◽

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.

Download Full-text