scholarly journals Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Umar Haruna ◽  
Gordon Dandeebo ◽  
Sylvester Z. Galaa
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Health Outcomes ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Transportation Systems ◽  
Successful Implementation ◽  
Maternal Healthcare ◽  
Focused Antenatal Care

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

scholarly journals Effects of Devolution on Maternal Health Care: The Case of Level Four Hospitals in Nairobi City County, Kenya

2019 ◽  
Vol 3 (II) ◽  
pp. 98-116
Author(s):  
Hudson Shilibwa Bulinda ◽  
Felix Kiruthu
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Professionals ◽  
Service Providers ◽  
Health Workers ◽  
Healthcare Services ◽  
National Government ◽  
Maternal Health Care ◽  
Maternal Healthcare ◽  
County Governments

Maternal healthcare is an integral part of the Millennium development goals. However, most developing countries have been experimenting with different types of interventions to increase access and utilization of maternal care services. Health care devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. Thus, this study assessed the effects of devolution on maternal health care in Nairobi City County in Kenya.  Particularly, the study examined the situation of maternal healthcare before and after devolution and how devolution as affected provision of maternal healthcare in Nairobi City County. The study also assessed how devolution affected maternal health care programs implementation and the challenges facing the devolved maternal health care in Nairobi City County. The study adopted the systems approach and the decentralization theorem. This study employed a descriptive research design and the population of the study was made up of the 4 level four hospitals in Nairobi County and all the 189 selected medical health workers in the hospitals. A sample of 57 respondents was selected through simple random sampling. Additionally, the study used questionnaires and an interviews guide to collect data. The questionnaires were administered to the sampled medical workers and the interviews schedules were administered to the key informants who comprised of the medical superintendent from every hospital. Quantitative data was collected through the use of the questionnaires was analyzed using descriptive statistics with the aid of the Statistical Package for Social Sciences. Qualitative data was analyzed using content analysis. The study found that the status of maternal healthcare infrastructure under devolution of health services in Nairobi was good. The findings also established that most health workers preferred that the national government should manage maternal health care infrastructure as opposed to county governments. The study further revealed that county governments had not instituted and implemented effective maternal healthcare programs formulated by the national government. Finally, the study concludes the major challenges influencing the implementation of maternal healthcare services include attitude and perception of health professionals, resistance of devolution by health workers, strikes by health workers, shortage of healthcare workers corruption and tribalism, increased pressure on hospital equipment and infrastructure and stock outs of essential commodities in the facilities affect devolved maternal health care. The study recommended that both the county and national government should work together and combine their efforts to enhance the devolved systems of healthcare so that they can enhance maternal healthcare. This is an open-access article published and distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License of United States unless otherwise stated. Access, citation and distribution of this article is allowed with full recognition of the authors and the source.

scholarly journals Regional differentials in early antenatal care, health facility delivery and early postnatal care among women in Uganda

2021 ◽  
Vol 13 (4(J)) ◽  
pp. 17-30
Author(s):  
Ruth Atuhaire ◽  
Robert Wamala ◽  
Leonard. K. Atuhaire ◽  
Elizabeth Nansubuga
Keyword(s):  
Antenatal Care ◽  
Community Health ◽  
Health Facility ◽  
Maternal Education ◽  
Health Workers ◽  
Healthcare Services ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Maternal Healthcare ◽  
Care Health

This study aimed at examining regional differentials in maternal healthcare services in Uganda. Using a sample of 1,521 women of reproductive ages (15-49) from Eastern and Western sub-regions of Uganda, and non-linear Oaxaca’ Blinder Multivariate Decomposition method, we assessed differentials in utilization of early antenatal care, health facility delivery and early postnatal care services among the women, henceforth, establishing main predictors of regional inequalities that will enable policymakers to make better evenly interventions and focused decisions. The study reveals that differentials in the utilization of maternal healthcare services are not only hindered by social and economic barriers, but also widespread disparities in the utilization of existing services. Significant differentials were attributed to both variation in women’s characteristics and effects of coefficients. Findings showed that the gap in early antenatal care would reduce on average by 31.6% and 34.7% of differences in availability of community health workers and media exposure respectively, were to disappear. Furthermore, the gap would increase on average by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth respectively. The gap in health facility delivery would reduce on average by 24.6% and 37.2% of differences in community health worker availability and media exposure were to disappear respectively and increase on average by 54.9% in the absence of variations in effects of maternal education. The gap in EPNC would reduce on average by 18.5% and 17.17% of differences in maternal education and community health worker availability were to disappear respectively and increase on average by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth respectively. Progress towards equitable maternal health care should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.

scholarly journals Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Petula Fernandes ◽  
Emmanuel Kolawole Odusina ◽  
Bright Opoku Ahinkorah ◽  
Komlan Kota ◽  
Sanni Yaya
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Reproductive Age ◽  
Maternal Healthcare ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan. Methods This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression. Results Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001). Conclusions Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

scholarly journals Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso

2020 ◽  
Vol 5 (9) ◽  
pp. e002879
Author(s):  
Thomas Druetz ◽  
Lalique Browne ◽  
Frank Bicaba ◽  
Matthew Ian Mitchell ◽  
Abel Bicaba
Keyword(s):  
Antenatal Care ◽  
Burkina Faso ◽  
Negative Binomial ◽  
Terrorist Attack ◽  
Healthcare Services ◽  
Terrorist Attacks ◽  
Cesarean Sections ◽  
Maternal Healthcare ◽  
District Hospitals ◽  
The Impact

IntroductionMost of the literature on terrorist attacks’ health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist attacks can be detrimental to access to healthcare services. The objective of this study is to assess the impact of terrorist attacks on the utilisation of maternal healthcare services by examining the case of Burkina Faso.MethodsThis longitudinal quasi-experimental study uses multiple interrupted time series analysis. Utilisation of healthcare services data was extracted from the National Health Information System in Burkina Faso. Data span the period of January 2013–December 2018 and include all public primary healthcare centres and district hospitals. Terrorist attack data were extracted from the Armed Conflict Location and Event Data project. Negative binomial regression models were fitted with fixed effects to isolate the immediate and long-term effects of terrorist attacks on three outcomes (antenatal care visits, of facility deliveries and of cesarean sections).ResultsDuring the next month of an attack, the incidence of assisted deliveries in healthcare facilities is significantly reduced by 3.8% (95% CI 1.3 to 6.3). Multiple attacks have immediate effects more pronounced than single attacks. Longitudinal analysis show that the incremental number of terrorist attacks is associated with a decrease of the three outcomes. For every additional attack in a commune, the incidence of cesarean sections is reduced by 7.7% (95% CI 4.7 to 10.7) while, for assisted deliveries, it is reduced by 2.5% (95% CI 1.9 to 3.1) and, for antenatal care visits, by 1.8% (95% CI 1.2 to 2.5).ConclusionTerrorist attacks constitute a new barrier to access of maternal healthcare in Burkina Faso. The exponential increase in terrorist activities in West Africa is expected to have negative effects on maternal health in the entire region.

Issues in the Provision of Health Care in India: An Overview

2020 ◽  
pp. 097674792094518
Author(s):  
Vani Kant Borooah
Keyword(s):  
Health Outcomes ◽  
Rural Areas ◽  
Health Workers ◽  
Tertiary Care ◽  
Health Resources ◽  
Successful Implementation ◽  
Trade Offs ◽  
Vested Interests ◽  
Explicit Recognition ◽  
Optimal Mix

After reviewing health outcomes and policy in India, this paper concludes that there are at least six sets of issues to be addressed about improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private-sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of the policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, a policy it is important to address these governance issues.

scholarly journals Cost of Ante-natal Care among Health Insurance (HI) Enrollees and Out-of-Pocket (OOP) Payers accessing Maternal Healthcare Services in a Tertiary Health Institution in Southwest Nigeria

2021 ◽  
Vol 9 (2) ◽  
pp. 11-22
Author(s):  
Taofeek Adedayo Sanni
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Healthcare Services ◽  
Reproductive Age ◽  
P Value ◽  
Maternal Healthcare ◽  
Cross Sectional ◽  
Health Institution ◽  
Total Cost ◽  
Southwest Nigeria

Maternal Mortality Remains A Leading Cause Of Death Among Women Of Reproductive Age Group. This Study Determined The Cost Of Antenatal Care Among Health Insurance (HI) Enrollees And Out-Of-Pocket (OOP) Payers Accessing Maternal Healthcare Services In A Tertiary Health Institution In Southwest Nigeria. A Comparative Cross-Sectional Study Was Carried Out Among 380 Women (190 HI Enrollees And 190 OOP Payers) Attending Antenatal Care Services In A Tertiary Health Institution In Southwest Nigeria Using A Systematic Random Sampling Technique. Data Was Gathered Using An Interviewer-Administered Semi-Structured Questionnaire And Analyzed Using IBM SPSS Version 23. Chi-Square And Binary Logistic Regression Were Used To Assess The Association Between Dependent And Independent Variables And A P-Value Of <0.05 Was Taken As Significant. The Overall Mean Age Of Respondents In This Study Was 33.8 ± 5.0 Years (HI Group: 34.1 ± 4.9 Years And OOP Group: 33.6 ± 5.0 Years). The Mean Total Cost Of Antenatal Care (ANC) Is Lesser For HI Enrollees (₦5,095.2 ± 1,753.1 Equivalent To $13.3 ± 4.6) As Compared With OOP Payers (₦15,050.6 ± 5,548.9 Equivalent To $39.6 ± 14.6). Predictors And Enablers For HI Uptake Are Marital Status, Family Size, Level Of Education, Occupation, Appropriate And Quality HI Package, And Trust In The HI Scheme. It Was Concluded That The Total Cost Of Antenatal Care Is Lower Among The Health Insurance Enrollees Than The Out-Of-Pocket Payers. Therefore, Interventions To Increase Awareness And Designing More Enticing HI Packages Are Recommended.

scholarly journals Maternal healthcare services use in Mwanza Region, Tanzania: A cross-sectional baseline survey

2019 ◽  
Author(s):  
James Orwa ◽  
Michaela Mantel ◽  
Micheal Mugerwa ◽  
Sharon Brownie ◽  
Eunice Siaity Pallangyo ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Health Facility ◽  
Healthcare Services ◽  
Facility Delivery ◽  
Postpartum Care ◽  
Reproductive Age ◽  
Antenatal Visit ◽  
Health Facility Delivery ◽  
Maternal Healthcare ◽  
Cross Sectional

Abstract Background: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania. Methods: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. Results: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. Conclusion: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services. Keywords: Antenatal care, health facility delivery, postpartum care, Mwanza, Tanzania

scholarly journals Contesting Representations of Refugee‑Background Women (and Men) as ‘Needy’ and  ‘Problematic’ in Healthcare Literature in Aotearoa New Zealand: Advancing the Case for a  Capability‑Driven Model

2021 ◽  
Author(s):  
◽  
Kristine Mary Ford
Keyword(s):  
New Zealand ◽  
Health Outcomes ◽  
Good Health ◽  
Healthcare Services ◽  
Health Needs ◽  
Biomedical Model ◽  
Maternal Healthcare ◽  
Starting Position ◽  
Aotearoa New Zealand ◽  
Improve Health

<p>This research analyses how power operates discursively within the western biomedical model as it pertains to the representations and treatment of refugee‑background women (and men) in Aotearoa New Zealand. It carefully investigates the tendency of current biomedical discourse to typecast women (and men) with refugee backgrounds as having considerable health needs, which predicates the (over‑) representation of them as exclusively ‘problematic’ and ‘needy’ throughout refugee and healthcare related literature. It also considers other ways in which the western biomedical model may be inappropriate and inadequate for refugee‑background communities. This thesis takes its starting position from some of the concerns regarding health outcomes raised in a meeting with three representatives of various refugee‑background communities in Wellington in 2011, and by the recent ChangeMakers Refugee Forum (CRF) (2011) report, “barriers to achieving good health outcomes in refugee‑background communities”. In light of these concerns (and subsequent recommendations), this research aims to introduce alternative narratives in the effort to improve health outcomes, as well as constitute a more fair and just discourse. The mentation of the thesis is heavily inspired by postdevelopment theory and its potential for more enabling and effective ways of ‘doing’ development. I draw on this theoretical frame to explore how an asset‑based approach to maternal healthcare services in Aotearoa New Zealand for refugee‑background women may be a vehicle to help us negotiate the politics of representation and generate better health outcomes for refugee‑background communitiescomes for refugee‑background communities.</p>

scholarly journals Health Literacy of Hearing-Impaired High School Students, Some of the Problem, and their Expectations

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Gür ◽  
G Dolaner ◽  
R Turan
Keyword(s):  
High School ◽  
High School Students ◽  
Health Literacy ◽  
Health Outcomes ◽  
Sign Language ◽  
Healthcare Service ◽  
Health Workers ◽  
Healthcare Services ◽  
Hearing Impaired ◽  
School Students

Abstract Purpose This study aims to determine hearing-impaired students’ levels of health literacy, problems when they receive healthcare service and their expectations. Methods This descriptive study was conducted on 88 hearing-impaired high school students over 15 years of age. The data collection tools used in the study are “Form of Problems Experienced When Receiving Healthcare Service”, “Form of Expectations from Healthcare Service”, and Turkey Health Literacy Scale (THLS-32). The researchers know sign language. The Health Sciences Faculty granted approval for the study (04.12.2017-255). The families were informed of the program through the school administration, and their consent was obtained. Results 70.5% of the students had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had communication problems with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (&lt;0.05). Those who stated that they did not understand what the nurses said (43.2%) and the health education materials (56.8%) and those who reported that they were confused when they had more than one appointment (20.5%) had significantly low THLS scores (&lt;0.05). 55.7% of them expected that their prescriptions or care procedures were to be given in writing, and 87.5% expected them to be told in sign language. Conclusions Most of of the participants have significantly weaker general health literacy. Students with low THLS scores have less understanding of the given information and have problems with health workers. Main messages: This can create disparities and inequalities in the use of healthcare services and in the health outcomes. Key messages This can create disparities and inequalities in the use of healthcare services. This can create disparities and in the health outcomes.

scholarly journals Towards Inclusive Healthcare Delivery: Potentials and Challenges of Human-Centred Design in Health Innovation Processes to Increase Healthy Aging

2020 ◽  
Vol 17 (12) ◽  
pp. 4551
Author(s):  
Catharina Thiel Sandholdt ◽  
Jason Cunningham ◽  
Rudi G.J. Westendorp ◽  
Maria Kristiansen
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Small Scale ◽  
Successful Implementation ◽  
Innovation Processes ◽  
Human Centred Design

National healthcare systems need to adjust services and operations to accommodate the needs of complex, aging populations living with multimorbidity and polypharmacy. This paper suggests the use of a human-centred design as a method to engage older adults and key professionals in innovation processes aiming to design person-centred healthcare services and improve quality of life in older adults. We outline three innovation phases and highlight how such processes can create engagement and new insights on how life experiences of older adult’s shape preferences, beliefs, and habits. It is important to incorporate these insights into the design of successful strategies for ensuring age-friendly healthcare services. Our viewpoint is contextualised through a small-scale case study focusing on polypharmacy in older adults. From this case study, we extracted three challenges to producing co-designed health research: recruitment, time and resources, and funding. We discuss how to address these challenges. We argue for the involvement of older adults and professional stakeholders at an early stage in the design process to align expectations and to increase the likelihood of successful implementation of healthcare innovations that improve the quality of life for older adults.

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